Protandim

By checking the box, I hereby certify that I have read and fully understand the following releases and representations. The testimonial and/or endorsement I have provided is truthful and accurate and reflects my honest beliefs and experiences regarding Protandim® and/or Lifevantage Corporation. The foregoing statement is in my own words, and I have voluntarily provided it to Lifevantage Corporation. I have personally used/taken, and am an actual consumer of Protandim.

I further certify that at the time I provided my endorsement or testimonial I did not receive, nor was I promised, any compensation for my statement.

I am not an employee of or consultant for Lifevantage Corporation, and I am not related to any owner, manager, director, consultant or employee of Lifevantage, Inc.

I consent to and authorize Lifevantage Corporation, its owners, affiliates, agents, representatives, and all persons or entities working on its behalf, to use my name, age, state of residence, statement(s), and/or the contents of my communications with Lifevantage Corporation (collectively the “Endorsement Material”), in whole or in part, in any and all media now or hereafter developed (including, but not limited to, television, radio, film, Internet, recordings, and print advertisements) for public release worldwide and without limitation in time. I agree that no advertisement or media release need be submitted to me for any further pre-approval, and that Lifevantage Corporation or entities working on its behalf may make reasonable edits to my Endorsement Material for public release.

I understand that Lifevantage Corporation may choose to use some, all or none of my Endorsement Material and that Lifevantage Corporation will retain the sole and exclusive ability to determine whether or not to post all or part of such Endorsement Material on its website or elsewhere.

I hereby release and discharge Lifevantage Corporation, its owners, affiliates, employees, agents, representatives, successors, affiliated and related companies, and licensees and assigns, from any and all claims, causes of action, and liability based upon use of my Endorsement Material, including but not limited to claims, causes or action, and liability for defamation, violation of any moral rights, invasion of right of privacy, publicity, or personality, or any similar matter.

I represent and warrant that I am over the age of twenty-one (21) years old.