NEW BA Membership/Payment Form (In-Person Baja)

Membership/Consultation Payment Form

(In-person consultation in Baja)
Thank you for your interest in applying for private membership at Sanguinity Now, Inc., a Nevada Corporation doing business as Bigelsen Academy! In order to purchase your consultation, you must become a member. If you would like more information about membership at Bigelsen Academy, please visit our website at www.BigelsenAcademy.com and/or ask us directly – we love talking about our work and are more than happy to answer your questions!

Total cost of the in-person consultation is $399, or consultation with treatments is $599. These consultations are only available in Playas de Tijuana, Baja.

Deposit of $199 is to be paid now with completion of this membership application. The remaining balance of $200 or $400 with treatments will be paid at time of consultation visit. Payment must be paid in US Dollars, or Mexican Pesos.

Consultation with treatments are available only after eligiablity has been determined. Eligiability will be determined through a qualifying interview, prior to the date of the consultation. A link to schedule the interview will be available once this form has been submitted.
Legal Name *

First Name Last Name
Date *

Month Day Year
Date
Date of Birth *

Month Day Year
Email *
example@example.com
Spanish Speaker *

Yes No
Consultation preference *

Consultation only ($399) Consultation with treatments ($599)
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Country *
Phone Number *

Area Code Phone Number
Referred by *
Why do you want to become a member of the Bigelsen Academy? *

PRIVATE MEMBERSHIP AT BIGELSEN ACADEMY. Bigelsen Academy operates as a private community of members organized under the First, Fourth, Fifth, Ninth, Tenth, and Fourteenth Amendments to the U.S. Constitution, and similar sections of various state constitutions. Members of Bigelsen Academy proclaim the freedom to choose, obtain, and interpret for ourselves the types of information and educational experiences we think best for learning about ourselves and for supporting us in our pursuit of achieving optimal wellness and well-being of our minds, bodies, and spirits. Members proclaim and reserve the right to choose sources of information and experiences that include and are not limited to cutting edge techniques and methods offered, used, or shared, whether traditional or non-traditional, conventional or unconventional. Bigelsen Academy coaches specialize in the Bigelsen MethodTM. Bigelsen Academy provides exclusive benefits to private members at an affordable fee.

MEMBERSHIP APPLICATION. Bigelsen Academy will recognize and permit any person that promises to adhere to the Mission, Purpose, and Policies of Bigelsen Academy to apply for membership in the private community. In consideration for the opportunity to be considered for membership at Bigelsen Academy, all applicants shall sign a contractual application for membership and pay the required one-time membership application fee of $99 United States Dollars.

DECLARATION OF PURPOSE. Bigelsen Academy is a private education and research community that operates in service to its members. At Bigelsen Academy, we declare that our purpose is to encourage and promote innovation and creativity in the fields of wellness education and preventative wellness through the development and sharing of research, information, products, services, and experiences with our private members. At Bigelsen Academy, we carry on the Lamarck Terrain Theory, and seek to educate and empower our members to take a proactive approach in managing their well-being.

MISSION STATEMENT: The mission of Bigelsen Academy is to assist our private members (individually) and society (collectively) on their journeys to learn more about their wellness and well-being by providing access to unique information, teachings, Educational Services, products, and experiences. We consider our mission a commitment to our members. We deliver on our commitment by providing a medium through which members can privately interact, communicate, coach, teach, exchange information, express themselves. The Academy strives to empower each member to make their own decisions concerning their own wellness, life, nutrition, spirituality, and wellness; and that of their family, dependents and pets.

BENEFITS OF MEMBERSHIP. Bigelsen Academy operates to provide its members with exclusive access to members-only benefits, including access to members-only Educational Services, events, webinars, community forums, experiences, and more. Membership benefits may change/evolve over time. The costs associated with participating in individual membership benefits are separate from required one-time membership application fee.

NONDISCRIMINATION. By signing this Membership Application, I acknowledge and understand that Bigelsen Academy has a firm nondiscrimination policy. In furtherance of that policy, Bigelsen Academy does not allow any discrimination of any kind based on age, birthplace, condition, creed, disability, disease, disorder, education, employment, family, family heritage, gender, wellness issues, heritage, illness, language, livelihood, mental capacity, nationality, opinions, personality quirks, place of residence, race, skin color, or any other known or observable “difference” between people.

MEMBER UNDERSTANDINGS: The Bigelsen Academy community of private members strives to maintain, protect, and improve the civil rights, constitutional guarantees, and freedom of choice regarding information and wellness strategies for every member. Bigelsen Academy membership is open to individuals who are interested to learn more about wellness and their bodies, and who are in agreement with each of the following:

(Please initial next to each numbered item below, before signing in the space at the bottom of this Membership Application)
Initials   1) PURPOSE & MISSION. I acknowledge, understand, and support the stated Purpose and Mission of Bigelsen Academy, and I hereby apply to become a member of the Bigelsen Academy private community; I include in my membership those members of my family, dependents, and pets whose names are listed alongside my name at the bottom of this application.
Initials   2) UNITED STATES CONSTITUTION. I acknowledge and understand that Bigelsen Academy operates as a private association of members that is organized under the First, Fourth, Fifth, Ninth, Tenth, and Fourteenth Amendments to the U.S. Constitution, and similar sections of various state constitutions, in order to provide me, my family and my dependents all the rights and protections set forth therein anywhere in the United States of America. I believe that the First Amendment to the U.S. Constitution is a tool designed to be used by innovators in striking the proper balance between the extremes of State police power and Individual rights – innovation and creativity need room to breathe in order to find solutions to everyday challenges.
Initials*   3) EXERCISE OF INALIENABLE RIGHTS. I acknowledge and understand that, if accepted as a member of Bigelsen Academy, I will be exercising my inalienable rights of Freedom of Speech and Freedom of Association, as guaranteed by the First and Fourteenth amendments to the U.S. Constitution and equivalent provisions of the various State Constitutions. I understand that the associational activities are offered exclusively to private members and are not made available to the general public. In signing and submitting this Membership Application, I acknowledge and understand that inherent in the Right of Association is the right not to associate. In order to best secure the ongoing integrity of Bigelsen Academy and its members, Bigelsen Academy shall have the power and sole discretion to determine if applicants are accepted as members.
Initals   4) LIMITATION OF LIABILITY; HOLD HARMLESS. By signing this Membership Application, I acknowledge and understand that I am responsible for the results my decisions have on me, my family, and my dependents; and I promise to hold Bigelsen Academy and all members of Bigelsen Academy harmless for any and all harm that I may cause to myself or others because of my decisions. If accepted as a member of Bigelsen Academy, I agree and promise that I will not initiate a lawsuit or other legal action against Bigelsen Academy for any reason – I will take full responsibility for any harm that may be caused to me, my family, and/or dependents as a result of my own decisions.
Initials   5) MEMBERSHIP DISCLAIMER. By signing this Membership Application, I acknowledge and understand that all educational services, products, and experiences are available to members for informational and educational purposes only, and are never to be used as a substitute for medical advice, examination, diagnosis, or treatment; Bigelsen Academy and Bigelsen Academy coaches do not and will not provide members with medical care, advice, diagnosis, or treatment. I should never treat myself based on information I receive from Bigelsen Academy. No information provided by Bigelsen Academy is regulated or evaluated by the State of Nevada or the United States Food and Drug Administration and, therefore, the information should never be used to diagnose, treat, cure, mitigate, or prevent any disease, injury, or condition without the supervision of an appropriately qualified medical professional. I understand that I should always seek the advice of my primary care physician or other qualified professional before altering current
exercise and/or dietary regimens, and before making lifestyle changes. IF ACCEPTED AS A MEMBER, I PROMISE THAT I WILL NOT ALTER OR STOP ANY OF MY MEDICAL PROGRAMS OR TREATMENT PROTOCOLS BASED ON INFORMATION RECEIVED THROUGH MY MEMBERSHIP AT BIGELSEN ACADEMY.
   Initials   6) CONFIDENTIALITY. By signing this Membership Application, I acknowledge and understand that it is my responsibility to, at all times, maintain strict confidentiality of all communications between me and other members of Bigelsen Academy, including all communications with Bigelsen Academy staff and coaches. I also understand that it is my responsibility to maintain the confidentiality of all communications of any association member I hear or inadvertently overhear at any time. I promise that any information I receive, say, write, or otherwise communicate under the umbrella of my membership with Bigelsen Academy is, and will be held, as absolutely confidential.
   Initials   7) INFORMED CONSENT. By signing this Membership Application, I declare that I have read and understand this Membership Application and that I am qualified and have mental capacity to make a decision to apply for membership in Bigelsen Academy to experience the products, services, and experiences offered to private members, and to learn how to improve and manage my own wellness, nutrition, therapies and wellness, and that of my family and my dependents.
   Initials   8) NEVADA HEALTH FREEDOM DISCLAIMER. I acknowledge and understand that it is recommended that, before beginning any lifestyle change or new wellness plan, I notify my primary care physician or other licensed providers of medical care of my intention to use wellness services, the nature of the wellness services, and any wellness plan that may be utilized. It is also recommended that I ask my primary care physician or other licensed providers of medical care about any potential drug interactions, side effects, risks or conflicts between any medications or treatments prescribed by my primary care physician or other licensed providers of medical care and the wellness services I intend to receive.
   Initials   9) EXECUTION OF MEMBERSHIP APPLICATION. By signing and submitting this Membership Application along with my one-time application fee payment of $99, I hereby apply for membership in Bigelsen Academy. I acknowledge and understand that additional terms will apply to those products, services, and/or experiences I choose to participate in as part of my membership experience. If accepted as a member, I expressly agree and promise to abide by the rules and regulations of Bigelsen Academy, and to respect and enforce all decisions of Bigelsen Academy. I understand that this application includes me, my family, dependents, and pets for all Educational Services, products, and/or experiences requested or approved by me, including and not limited to: Holographic Blood® observation services, Educational Reports, coaching, demonstrating, discussing, educating, examining for knowledge, explaining, facilitating, mentoring,

I Agree *

I confidentially apply to join The Bigelsen Academy, under Section Two of the Canadian Charter of Rights and Freedoms and the Bill of Rights in the US Constitution. I hereby claim sanctuary under these rights and freedoms, and in token hereof sign this application without prejudice. I also understand that the educational consultation report is for informational purposes only and is not a substitute for professional medical or health advice, examination, diagnosis, or treatment. Always seek the advice of your health care professional or other qualified health professional before starting any new therapy, making any changes to existing therapy, or altering in any way your current exercise or diet regimen. I will not publish or share this information without the permission of The Bigelsen Academy
I hereby seek membership at Bigelsen Academy on behalf of my Child, Dependent, and/or Pet. List the name & D.O.B. foreach Child, Dependent and/or Pet:
Signature

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In-person Consultation Deposit (Baja) $ 199.00

Deposit for 'In-person consultation' ($399) or 'In-person consultation with treatments' ($599). Remaining balance of $200 or $400 (with treatments) must be paid in US dollars, or Mexican pesos at time of consultation.

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