MitoZenPMA

APrivateMembershipAssociation MEMBERSHIP CONTRACT

I,                                                       , for membership fee paid in hand, do hereby apply for membership in MitoZen PMA, a private membership organization.With the signing of this membership agreement,I/weaccepttheoffermadetobecomeamemberof MitoZenPMAandhavereadandagreewith the following Declaration of Purpose from Article I of MitoZen PMA’s Articles of Association.

1.    This Association of members hereby declares that our main objective is to maintain and improve the civil rights, constitutional guarantees, and political freedom of every member and citizen of the United States of America.We believe and affirm that the Constitution of the United States is one of the best documents ever devised by man, and the signers of the Declaration of Independence did so out of love for their country.

2.    We believe that the First Amendment of the Constitution of the United States of America guarantees our members the rights of free speech, petition, assembly, right to contract, and the right to gather together for the lawful purpose of advising and helping one another in asserting our rights under the federal and state constitutions and statutes.We strive to maintain and improve the civil rights, constitutional guarantees, freedom of choice in health care and political freedom of every member of this Association.

IT IS HEREBY Declared that we are exercising our right of “freedom of association” as guaranteed by the First and Fourteenth Amendments of the U.S. Constitution and equivalent provisions of the various state constitutions.This means that our Association activities are restricted to the private domain only.

3.    We declare the basic right of all our members to select spokesmen from our number who could be expected to give wisest counsel and advice concerning the need for physical and mental health care assistance and to selectfrom our number those memberswho are themostskilled to assist and facilitate the actual performance and delivery of care.

4.    We proclaim the freedom to choose and perform for ourselves the types of therapies and modalities that we think best for assessing and preventing illness of our minds and bodies and for achieving and maintaining optimum wellness.We proclaim and reserve the right to include health options that include, but are not limited to, cutting edge modalities and therapies practiced or used by any types of healers or therapists or practitioners the world over, whether traditional or nontraditional, conventional or unconventional.

5.    The mission of our Association is to provide members with the highest level of quality care and the most effective methods available.We emphasize our member’s health condition, and not merely the symptoms experienced.Our Association understands that wellness has many dimensions and strives every day to stay on the leading edge of new technology.The Association provides comprehensive, conventional, complementary, alternative care and advanced technologies for all aspects of a member’s health and provides the most effective means of care at an affordable fee.More specifically, our Association provides members with health and wellness services and products to include health coaching programs, health-related treatments and health-related supplement protocols and supplements which may include nasal sprays, suppositories, eyedrops and liposomal oral products.In addition, educational seminars, online educational material, health-related articles, video content and live events will be accessible and available for the benefit to its members.

6.    The Association will recognize any person (irrespective of race, color, or religion) who is in agreement with these principles and policies as a member and will provide a medium through which its individual members may associate for actuating and bringing to fruition the principles and purposes heretofore declared.
 
MEMORANDUMOFUNDERSTANDING

I understand that the fellow members of the Association that provide services and care, do so in thecapacity of afellowmember and notin the capacity as a licensed health careprovider.I further understand that within the association no doctor-patient relationship exists but only a contract member-member Association relationship.In addition, I have freely chosen to change my legal status as a public patient or client to a private member of the Association. I further understand that it is entirely my own responsibility to consider the adviceandrecommendations offered tomeby myfellow members andtoeducate myself as to the efficacy, risks, and desirability of same and the acceptance of the offered or recommended therapy, technique, assessment, advice and care is my own carefully considered decision.Any request by me to a fellow member to assist me or provide me with the aforementioned recommendation, therapy, technique, assessment and care is my own free decision in an exercise of my rights and made by me for my benefit, and I agree to hold the Trustee(s), staff and other worker members and the Association harmless from any unintentional liability for the results of such care, except for harm that results from instances of a clear and present danger of substantive evil as determined by the Association, as stated and defined by the United States Supreme Court.

The Trustee and members have chosen John Lieurance, ND, DC, BS, RMA, DABCN as the person best qualified to perform services to members of the Association and entrust him to select other members to assist him in carrying out that service.

In addition, I understand thatsince the Association is protected by the First and Fourteenth Amendments to the U.S. Constitution, it is outside the jurisdiction and authority of Federal and State Agencies and Authorities concerning any and all complaints or grievances against the Association, any Trustee(s), members or other staff persons.All rights of complaints or grievances will be settled by an Association Committee and will be waived by the member for the benefit of the Association and its members. Because the privacy and security of membership recordsmaintainedwithin the Association which have been held to be inviolate by the U.S. Supreme Court, the undersigned member waives HIPAA privacy rights and complaint process.Any medical or healthcare records keptby the association will be strictly protected and only released upon writtenrequest of themember.Iagreethat violationof any waivers inthismembership contract will result in a no contest legal proceeding against me.In addition, the Association does not participate in any medical insurance plans or collections on behalf of the member but will provide asuitable invoice for the member to pursue reimbursement by his/her insurance company, if applicable.

I agree to join the Association, a private membership association under common law, whose members seek to help each other achieve better health and live longer with good quality of life.

I understand that the doctors, nurses, and other providers who are fellow members of the Association are offering me advice, services, and benefits that do not necessarily conform to conventional medical care.I do not expect these benefits to include on-call coverage, hospital care, or the usual and customary care provided by most physicians.I will receive such primary and specialist care elsewhere.I fully understand that the benefits I receive from the Association might or might not be covered by my health insurance and not at all by Medicare.

As a member, I accept the goals of helping my body function better and choosing techniques that are both verysafeandhaveareasonablygoodchancetosucceed,realizingthatnotherapyortechniqueisfoolproof. If I choose to forgo drugs, surgery, or radiation that has been recommended to me by others, I fully accept the risk that I might suffer serious consequences from that choice.Other aspects of informed consent will take place in my discussions with the providers and my fellow members of the Association.

MyactivitieswithintheAssociationareaprivatematterthatIrefusetosharewiththeStateMedical Board, the FDA, FTC, Medicare, Medicaid or my own insurance company without my expressed specific permission.All records and documents remain as property of the Association, even if I receive a copy of them.I fully agree not to file a malpractice lawsuit against a fellow member of the Association unless that member has exposed me to aclear and present danger of substantive evil.I acknowledgethat the members of the Association do not carry malpractice insurance.
 
ZEN Meditation Mist Agreement

As a member of MitoZen PMA, I agree to responsibly use Zen Meditation mist. 
By signing this agreement, I agree to the descriptions of use outlined in this agreement.

Zen Use- I agree to use Zen as described below:

For first-time users: Make sure you are sitting and in a quiet and safe place. Start with one spray on the left side and DO NOT inhale. Simply spray Zen into the nostril. Blow your nose 15-30 seconds after you spray the ZEN Meditation Mist. A burning sensation is normal, and you may also feel lightheaded or even nauseous.  With higher dosing, vomiting can occur. Allow yourself 20-30 minutes to experience the sensations. Once you have experienced your reactions you can do a spray in both nostrils and wait longer before blowing your nose. Blowing your nose is optimal, and can prevent a drip back into the throat, that for some is undesirable. 

I agree to use ZEN Meditation Mist responsibly. I will use it without combining it with alcohol or any other illicit drugs. ZEN can be used in ceremonies with substances under the supervision of a facilitator, who is familiar with Hape’. I agree to not use ZEN Meditation Mist more than 5 times a day, and if I find myself using it more often, and having cravings for Zen, I will report this to one of the Mitozen PMA members working at the main office. 

Sharing Zen: I will not share ZEN Meditation Mist with non-MitoZen PMA members. Before sharing, I will have individuals sign up as members at MitoZen.club.

Addictive Potential of Nicotine contained in ZEN:  ZEN Meditation Mist contains natural nicotinederived from the mapacho tobacco plant from the Amazon.  I have been informed of the addictive potential and dangers associated with the consumption of nicotine. I understand that nicotine is addictive, and can lead to health risks when vaporized or smoked. 
Intra-nasal consumption may also propose risks as well such as:

Irritation to nasal tissues: Intra-nasal nicotine use can cause irritation, inflammation, and damage to the delicate tissues inside the nose. Prolonged use or excessive dosage may result in nasal dryness, nasal congestion, nosebleeds, or even ulceration.

Allergic reactions: Some individuals may develop allergic reactions to intra-nasal nicotine, which can manifest as itching, redness, swelling, or hives. In severe cases, an allergic reaction may lead to difficulty breathing or anaphylaxis, a potentially life-threatening condition.

It is important to note that the risks mentioned above may vary in severity and occurrence depending on individual factors, such as pre-existing medical conditions, dosage, and frequency of use. It is always advisable to consult a healthcare professional before initiating the use of ZEN Meditation Mist, to assess potential risks and determine the most appropriate course of action.

 

There are also potential benefits to the brain from nicotine use as well as managing certain medical conditions, such as Parkinson's disease, as supported by scientific research. 

By signing below, I acknowledge that I have read and understood the contents of this contract, and I voluntarily assume all risks associated with ZEN Meditation Mist use while recognizing the importance of using it responsibly and strictly adhering to these guidelines. 

I enter into this agreement of my own free will or on behalf of my dependent without any pressure or promise of cure.I affirm that I do not represent any State or Federal agency whose purpose is to regulate and approve products.I have read and understood this document, and my questions have been answered fully to my satisfaction.I understand that I can withdraw from this agreement and terminate my membership in this association at any time.These pages and Article I of the Articles of Association of the Association consist of the entire agreement for my membership in the Association and they supersede any previous agreement.

I understand that the membership fee entitles me to receive those benefits declared by the Trustee(s) to be “general benefits” free of further charge.I agree to pay as levied those benefits that I receive that are declared by the Trustees to be “special assessments”, per Fee Schedule.

I enclose a donation as consideration for my one-time lifetime membership contract, said term beginning with the date of the signing of this contract, and by these presents do hereby certify, attest and warrant that I have carefully read the above and foregoing MitoZen PMA’s Contractual Application for Membership and I fully understand and agree with same.

INWITNESSWHEREOF Iset myhandthis                      day of                      , 20.

                                                                                                                                                                                                                            

 

Member’sName    (NameoflegalguardianifApplicantunder18years,ifapplicable)

                                                                                                                                                                                                                            

 

Member’sSignature    (SignatureoflegalguardianifApplicantunder18years,ifapplicable)

Member’sContactInformation:

                                                                                                                                                                                                                            
Street    City    State    ZipCode

                                                                             
home/work/cellnumbers  

                                                                                                                                                                                                                            

 emailaddress

MitoZenPMA

By                                                                      

Approvedandaccepted this                      day of                      , 20           .