DECEMBER 2nd-5th, 2010 — LAS VEGAS

Seminar Date: SBC - Dec 2nd-5th 2010 - Las Vegas, NV First Name: Last Name: Email: Phone:  **No dashes in phone numbers. Address: City: State/Province: Zip/Postal Code: Seminar Bootcamp Voluntary Release Form I release and hold harmless Prosperity Alliance, which includes Marshall Sylver, Prosperity Alliance, and all Prosperity Alliance representatives, officers, employees, assistants, sponsors and organizations permitting the event described below to take place on the property including but not limited to: Venue where "Seminar Bootcamp" is being held And their representatives, officers, employees and directors for any and all damages to my person whether mental and/or physical and/or psychological which might occur by my voluntary decision to participate in "Seminar Bootcamp" at the above named location. I am completely aware that at the seminar given by Prosperity Alliance I will be given the opportunity to do many things. I fully recognize that the things I do possess real dangers and there is a possibility that I may receive severe burns or cuts or other serious injury, whether it be physical and/or mental and/or psychological. If I do choose to participate in these exercises, it will be completely my voluntary decision to do so, and I am fully aware that there are absolutely no guarantees regarding my safety. No mass distribution of outside promotional material (i.e. flyers, brochures, ect.) will be allowed without express written approval from Prosperity Alliance The use of any audio or video recording equipment during the Seminar Bootcamp is strictly forbidden I grant Marshall Sylver, and Prosperity Alliance, the right to photograph and record my name, voice, appearance and likeness and any matter of material furnished by me. If the program or portion in which my name, voice, appearance, or likeness or any matter or material furnished by me is recorded, photographed, broadcast, or sold, I hereby release said matter in perpetuity to Marshall Sylver and Prosperity Alliance without prejudice and acknowledge that I am to receive no compensation for such appearances or recordings. This agreement is full and binding and is the total extent of my agreement with Marshall Sylver and Prosperity Alliance. No other verbal agreements or statements have been made. Absolutely no promises or inferences of employment or employment opportunities have been made to me regarding Prosperity Alliance. Event starts promptly at 9:07am on Thursday. Should anyone arrive after 11:00am on Thursday, they will not be admitted into the seminar. By clicking the check box on the registration form, I acknowledge that I have been given the opportunity to ask questions regarding my voluntary participation in this program and any aspect of this release form. I assume any and all risk of injury or damage that might occur, and I agree that if I do incur any injury or damage by my voluntary decision to participate, I personally accept complete responsibility for those consequences and agree to hold harmless, and release from any liability, whatsoever, including financial retribution or reimbursement of any of the above named parties. I understand and agree to each and every term of this RELEASE FORM. I have read and agree to the terms of this release form. *Investment Required  *All fields are required.