Submission form – Mentalwellnesslab

Instructions

When submitting your photo, please ensure that it meets
the following specific requirements for acceptance:

1) The photo should be a clear image of your face, taken within the last six months.
2) Eyeglasses and hats should be removed.
3) The background should be plain white or neutral off white, without shadows,
patterns, paintings, pets, people, furniture, etc. in the background.
4) Photos should not be digitally enhanced, cropped, or altered in any way.

Thank you for your very kind cooperation!

PLEASE NOTE:
If you move to another city/state/country,
you’ll need to let us know via email, in order for the broadcast to have maximum effect!

Your photo and ALL of the below information is REQUIRED in order to
ensure that your personal broadcast experience achieves maximum results.

First Name

Last Name

If someone purchased a broadcasting service on your behalf, list their FULL NAME immediately below:

Email Address

Passport-Style Photo

Date of Birth

City

State / Province

Country of Residence

NOTE: If you plan on *moving* to another city/state/country... list your new location **below**

IMPORTANT:
We will never sell, rent, or share your personal information with any third parties,
for any reason, whatsoever. We sincerely value and appreciate your privacy!

Instructions

When submitting your photo, please ensure that it meets the following specific requirements for acceptance:

PLEASE NOTE: If you move to another city/state/country, you’ll need to let us know via email, in order for the broadcast to have maximum effect!

Your photo and ALL of the below information is *REQUIRED* in order to ensure that your personal broadcast experience achieves maximum results.

IMPORTANT: We will never sell, rent, or share your personal information with any third parties, for any reason, whatsoever. We sincerely value and appreciate your privacy!

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When submitting your photo, please ensure that it meets
the following specific requirements for acceptance:

PLEASE NOTE:
If you move to another city/state/country,
you’ll need to let us know via email, in order for the broadcast to have maximum effect!

Your photo and ALL of the below information is REQUIRED in order to
ensure that your personal broadcast experience achieves maximum results.

IMPORTANT:
We will never sell, rent, or share your personal information with any third parties,
for any reason, whatsoever. We sincerely value and appreciate your privacy!