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In this Release Statement I affirm that my weight loss is attributable to following the Atkins Diet and Nutritional Approach (the “Atkins Diet”) and I have not used any weight loss diet pill or other regimen to achieve my weight loss. I further affirm I have never, at any time in my life, undergone any bariatric surgical procedure, such as gastric bypass, Lap-Band, or stomach stapling, to lose weight.
I understand that by submitting this form I am representing that my personal weight loss story is true and accurately reflects my personal experience following the Atkins Diet (collectively “Success Story”). I further understand that by voluntarily submitting my Success Story Atkins may use in perpetuity my name, image, likeness, voice, identifying characteristics, testimonial and endorsement statements to promote the Atkins Diet and Products on its web site and/or other similar formats designated by Atkins (i.e. digital, television, social media, public relations).
I waive all rights and claims relative to Atkins’ use of my Success Story in any version or media, including, without limitation, rights and claims relating to copyright, libel, rights of privacy or publicity, and confidentiality.
