Submit a Testimonial

Please read the following information if you wish to leave a testimonial. We greatly appreciate your feedback!

Authorization and Release Information

I understand that my testimonial, as outlined above (the “Testimonial”) and made on behalf of Focused Life-Force Energy (hereinafter called “The Company”), may be used in connection with publicizing and promoting The Company.

I authorize The Company to use:

a) the Testimonial as defined on this form;

b) as an identifier, either my initials or my first name & last initial and the state/country (please indicate);

c) brief biographical information (sometimes our customers like to include the name of their own business or the organization they work for or the city they live in – please advise)

I hereby irrevocably authorize The Company to copy, exhibit, publish or distribute the Testimonial for purposes of, including but not limited to, publicizing The Company’s programs or for any other lawful purpose deemed necessary. These statements may be used in printed publications, multimedia presentations, websites, social media platforms, or other distribution media. I agree that I will make no monetary or other claims against The Company for using the statement.

In addition, I waive any right to inspect or approve the finished product, including a written copy, wherein my likeness or testimonial appears.  I hereby hold harmless and release The Company from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators or any other persons acting on my behalf, or on behalf of my estate, may have because of this authorization.

I have read the authorization & release information and willingly give my consent for its use as indicated above.

By filling out the form below and clicking submit, I am authorizing the company to use the biographical information provided in the testimonial, and I am giving my consent that I have read, understood, and agreed to the above information!