SIBO Made Simple Ambassador Application
Hello SIBO Amigos! I'm so thrilled you're interested in testing recipes for my new book, SIBO Made Simple, and offering your feedback. The requirements of participation are minimal: 1) testing 3+ recipes before August 31st 2019, 2) participating in the occassional group chat to help me gauge what SIBO questions/topics are the most useful to include in the book, and 3) writing an Amazon review of the book once it hits shelves. There will be a private Facebook group for our committee, but participation in that is not required!
Name
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Contact email
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City, State
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Do you have SIBO or have a history of SIBO?
If "No," anything else I should know about your health?
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Why do you want to become an ambassador of this project?
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Do you follow a specific diet?
If "other," please explain:
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Are there any other food allergies or limitations I should know about?
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Liability Release
By entering your initials below, you (The Client) herby releases, indemnifies, and holds harmless, the Service Provider (Phoebe Lapine from any and all manner of actions, causes of action, suits, proceeding, debts, dues, contracts, judgments, damages, claims and demands whatsoever in law or equity stemming from the agreement between the below mentioned parties. The Client expressly agrees that this release, waiver, and indemnity clause is intended to be as broad and inclusive, and if any portion thereof is held invalid, it is agreed the balance shall, notwithstanding, continue in full legal force and effect. The Client has carefully read the foregoing release and indemnification clause and understand the contents thereof. The Client acknowledges and is made fully aware that Phoebe Lapine is not a medical doctor and that the Service Provider is only providing recommendations to The Client in question. The Client acknowledges before beginning, implementing, or using any and all of recommendations provided, that client should consult a medical doctor.
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NDA / Confidentiality
I shall hold and maintain the Confidential Information passed on to me during my time as a Client of Phoebe Lapine in strictest confidence, understanding it is for my sole and exclusive benefit. I shall carefully restrict access to Confidential Information (including all Electronic Communication, such as my wellness program materials) to third parties as is reasonably required. I shall not, without prior written approval of Phoebe Lapine, publish, copy, or otherwise disclose to others, or permit use by others for their benefit or to the detriment of Phoebe Lapine, any Confidential Information.
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