Membership Form (non-USA)

Having paid the pertinent membership fee, I do hereby apply for membership in Accessing Health - Private Membership Association (“Association”). With the signing of this Membership Agreement (“Agreement”) I accept the offer made to become a member of the Association and have read and agree with the following Declaration of Purpose from Article I of the Articles of Association.

This Association of members hereby declares our main objective is to protect our rights to freedom of choice regarding our health information and care by exercising our Constitutional rights.

More specifically, the mission of our Association is to regain, maintain, and improve our health, vitality, and quality of life as well as improve our environment, both external and internal, seeking to achieve optimum levels of wellness and increased longevity. This can be accomplished through, but not limited to, foods, bio-nutrients, clean and vitalized waters, clean air, sunshine, exercise, quality rest, and the use of bio-functional testing technologies, bio-energetic evaluations, and wellness enhancing modalities, methods, techniques, and technologies.

We believe the First Amendment of the Constitution of the United States of America guarantees our members the rights of free speech, religious exercise, petition, assembly, and the right to gather together for the lawful purpose of advising and helping one another in achieving the objectives stated herein.

We believe the goal and mission of healing is the optimal restoration of our vitality and physical organism while seeking God and His Will for us.

We proclaim the freedom to choose and perform for-and-on ourselves the types of nutritional and energetic modalities we believe best for evaluating our health status and nourishing the normal form and function of our minds and bodies, and for achieving and maintaining optimal wellness so that each individual member can better express his or her own destiny, purpose, and mission in life. We proclaim and reserve the right to utilize any and all health options including, but not limited to, alternative, homeopathic, investigational and experimental modalities, practiced or used by any type of healer or practitioner the world over, whether traditional or nontraditional, conventional or unconventional, presently known or yet to be discovered.

We believe each member is responsible for their own health. We believe all members have the right to make informed choices concerning matters of their own health and that of their family, and therefore the Association encourages each member to fully explore all currently available health and treatment options. We believe it is mankind's God-given right to endeavor to transform disease to a state of health. The Association will offer recommendations to members regarding the various means making this possible.

We further declare the right and intent of our members to select from our number those who could be expected to give wise counsel and advice to our members concerning the foregoing knowledge and applications, to perform appropriate tests, make evaluations, recommend, and assist in the administration of certain and specific modalities for the purpose of accomplishing the objectives stated herein. It is the right of all members to learn from each other, assist each other, and to speak on these matters.

The Association will recognize any person (irrespective of race, color, or national origin) who is in agreement with the principles and policies of these Articles of Association and will provide media, printed, digital or otherwise, through which its individual members may associate for actualizing and realizing the objectives stated herein.

I understand fellow members of the Association providing recommendations, education, or care, do so in the capacity of a fellow member and not in the capacity as a licensed health care provider. I further understand that within the Association no doctor-patient relationship exists but only a member-member Association relationship. In addition, I have freely chosen to change my legal status as a public patient to a private member of the Association. I further understand it is entirely my own responsibility to consider the advice and recommendations offered to me by my fellow members and to educate myself as to the efficacy, risks, and desirability of same and the acceptance of the offered or recommended programs, care, and products, is entirely my own carefully considered decision. Any request by me to a fellow member to assist me, or to provide me with recommendations, education, or care, is my own free decision in an exercise of my rights and made by me for my benefit. I agree to hold the Trustee(s), staff and other worker members and the Association harmless from any unintentional liability, 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.

Pursuant the Articles of Association, the Trustee(s) have chosen Lorraine G. Mettlach-Larzabal as best qualified to provide the necessary leadership in the execution of services to members of the Association, and entrust her to select other Association members, or non-member outside third parties, to assist her in carrying out said service to members.

In addition, I understand since the Association is protected by the First and Fourteenth Amendments to the U.S. Constitution, it is therefore 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), member(s) or other staff member(s). All rights of complaints or grievances will be settled by an Association committee duly formed and will be waived by the member for the benefit of the Association and its members. Because the privacy and security of membership records maintained within the Association, having been held to be inviolate by the U.S. Supreme Court, the undersigned member waives HIPAA privacy rights and complaint process. Records kept by the Association will be strictly protected and only released upon written request of the member. I agree any violations I commit may result in the suspension or termination of my Membership. In addition, the Association does not participate in any medical insurance plans or collections on behalf of the member.

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 the service 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 the benefits I receive from the Association are not covered by my health insurance or Medicare.

As a member I accept the goals of helping my body function better and choosing techniques that are safe and have a reasonably good chance to succeed, realizing that no evaluation technique or remedy is foolproof. Other aspects of informed consent may take place in my discussions with Association service providers and my fellow members. 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 said choice.

My activities within the Association are a private matter that I willingly refuse to share with State officials, State Medical Boards, the FDA, Medicare, Medicaid, or my own insurance company, without expressed specific permission from the Association. 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 any fellow member of the Association, unless that member has exposed me to a clear and present danger of substantive evil. I acknowledge the members of the Association do not carry malpractice insurance.

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 I do not represent any State or Federal agency whose purpose is to regulate the practice of medicine. I have read and understood this document and my questions have been fully answered to my satisfaction. I understand I can withdraw from this Agreement and terminate my membership in this Association at any time. I further understand my membership in the Association may be suspended or terminated at any time by the Trustee(s). These pages and Article I of the Articles of Association consist of the entire Agreement for my membership in the Association and supersedes any previous membership agreement(s) with the Association.

I understand that my membership entitles me to receive benefits declared by the Trustee(s) to be “general benefits” free of charge. I further agree to pay for those benefits I receive that are declared by the Trustee(s) to be “special assessments."

By signing this contract I do hereby certify, attest and warrant that I have carefully read the above and foregoing Accessing Health Private Membership Association Membership Agreement, and fully understand and agree with the same.