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Get HealthyWage Verify Me

9/3/2014 https //www. healthywage. com/verifiers/verifyme/70114/ Verify Me Option 1 Veri er Submits Participant Info Online St e p On e St e p Two St e p Th re e Participant reviews the instructions e.g. what to wear Verifier personally takes the participant s measurements weight in pounds height in inches Verifier visits https //www. healthywage. com/verifiers/ https //www. healthywage. com/verifiers/ and follows the on-screen instructions For Option 1 you do N OT ne e d to comple te the informa tion be low. Participant Submits This Form Online St e p F ou r Verifier completes the form below Participant scans or takes a picture of this form and uploads it at By s ubmitting this form you a re giving your ve rifie r pe rmis s ion to re port your we ight he ight a nd a ll othe r pe rs ona l informa tion to H e a lthyWa ge Participant Info First Name HealthyWage No. Li s a 1088962725 Last Name Email M i n i ch i e l l o l m i n i h an s e n yah oo. Healthywage. com/verifiers/ https //www. healthywage. com/verifiers/ and follows the on-screen instructions For Option 1 you do N OT ne e d to comple te the informa tion be low. Participant Submits This Form Online St e p F ou r Verifier completes the form below Participant scans or takes a picture of this form and uploads it at By s ubmitting this form you a re giving your ve rifie r pe rmis s ion to re port your we ight he ight a nd a ll othe r pe rs ona l informa tion to H e a lthyWa ge Participant Info First Name HealthyWage No. Li s a 1088962725 Last Name Email M i n i ch i e l l o l m i n i h an s e n yah oo. com Veri er Info PLEASE NOTE Each item is required verification cannot be accepted without identity. Participant Submits This Form Online St e p F ou r Verifier completes the form below Participant scans or takes a picture of this form and uploads it at By s ubmitting this form you a re giving your ve rifie r pe rmis s ion to re port your we ight he ight a nd a ll othe r pe rs ona l informa tion to H e a lthyWa ge Participant Info First Name HealthyWage No. Li s a 1088962725 Last Name Email M i n i ch i e l l o l m i n i h an s e n yah oo. com Veri er Info PLEASE NOTE Each item is required verification cannot be accepted without identity. Phone Number Workplace Name Title/Position Workplace Postal Code Certi cation Of Measurements Weight Date of Measurement I the Verifier named above affirm under penalty of perjury pursuant to 28 U.S.C. Empty not leaning on anything ect. and honest and nothing interfered with the measurement. Signed Date Signed About Healthywage been featured multiple times on NBC s Today show CNN Time magazine Consumer Reports and hundereds of other media outlets. Many Fortune 500 companies universities school districts and insurers rely on HealthyWage for innovative weight loss solutions. Phone Number Workplace Name Title/Position Workplace Postal Code Certi cation Of Measurements Weight Date of Measurement I the Verifier named above affirm under penalty of perjury pursuant to 28 U.S.C. 1746 that I personally took the weight and height of the individual named above on the date named above that I took care to make sure the participant s weight and height were accurate no shoes minimal clothing hands/mouth/ect.

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