Analysis/Session work Release Form

I, _____________________________________________________________________,

of _____________________________________________________________________

(address)

hereby agree to permit my conversation to be recorded and/or videotaped and analyzed for speech reversals. I understand that either David John Oates or a person affiliated with Reverse Speech Enterprises, Inc. or as Student, Investigator, Analyst or Practitioner will analyze these taped recordings and document what they believe to be speech reversals using the accepted research procedures for the location of speech reversals. Such location techniques are referred to as “The Reverse Speech Process.”

I understand that the process is inexact and subject to interpretation by the individual analyzing the tape, and such interpretation, in both the reversals identified and in their interpretation, can be inaccurate. I understand that the words documented as speech reversals can have different meanings from those commonly associated with those particular words. I further understand that unconscious mental processes that are not yet fully understood may be activated by this procedure and that, as a result, certain mental, emotional and consequently physical, lifestyle and financial effects may occur. I am aware of, and consent to, these possible side effects and I will indemnify you for all and any legal claims resulting .

I hereby waive and release David John Oates, Reverse Speech Enterprises, Inc, Reversespeech.com, and their affiliates, directors, officers, Practitioners, Analysts, Investigators, Students and staff from any claims by me arising out of the use of these recordings of my voice or the filming of my likeness as permitted hereby, and any subsequent session work resulting from these recordings and its effects. I further waive and release David John Oates and/or his agents from any consequences that may be experienced by me during, or as a result of, any hypnotic or therapeutic techniques used during this session work process.

I agree that the recordings are the property of George Duisman and that they can be used as a part of the research efforts of the corporation and organizations and persons affiliated and/or certified by it. I agree that sections of the recordings can be published in written, audio and/or visual form and used in a commercial manner, with no compensation to me, as long as my identity is not disclosed.

Signed: _________________________________________________________________

Printed Name: ___________________________________________________________

Date: __________________________________________________________________