W W W . B E L L I S M . C O M

A unique opportunity for breakthrough growth and personal development. To help you better understand what we expect to achieve during this two-day process, here is an overview.

The following currently exist or are being developed for inclusion in the i am that girl training:

Exercises: to help participants relate to and own what they are learning

Tools: affirmations, imagery, goal-setting, journaling, peer support, and more

Video: relevant 15-minute interviews professionally branded “edutainment”

Audio and e-learning: Follow-up via our Web site, podcasts, CDs, etc.

Success stories: to motivate and inspire. Real testimonials (before & after) Quotes: from celebrities and others who can serve as role models

The Seven Fundamentals you’ll learn about in these two days are based on many years of research. They’re also based on the actual experiences of people from all walks of life. These Fundamentals are both timeless and leading edge. They make good science and good sense. Using them can help you to create and enjoy more success and happiness, now and in the future. As we’ve mentioned, a great deal of research, time and effort has gone into creating this workshop and bringing it to you. Everything you will hear or read can be validated by other sources, and nothing you'll learn is controversial. You can rely on the truth of the material we present, and you can verify it yourself.

Be THAT GIRL and go BELLISTIC!

BELLISM a beauty revolution workshop helps you feel empowered and confident. It helps you get your mojo working, gives your perspective a makeover, and celebrates the uniqueness and beauty of every girl and woman. BELLISM is a Beauty Revolution that can do great things for you and the world around you. It’s all about expanding our culture’s narrow definition of “beauty” to include not just what is on the surface, but all the good things underneath.

p r e s e n t e d b y : A L E X I S J O N E S

W W W . B E L L I S M . C O M

2010 Application And Medical Release Form (one form per child)

NAME: _________________________________________ GENDER: _____________ AGE__________ STREET ADDRESS: ___________________________________________________________________________ CITY: _____________________________________ STATE: ________________ ZIP: _______________ PARENT'S NAME: ______________________________ DAYTIME PHONE NUMBER: ___________________ EMERGENCY CONTACT NAME: ______________________ DAYTIME PHONE NUMBER: _______________ EMAIL ADDRESS:_____________________________________________________________________________

CHECK AGE: Ages 12: _______ 13: _______ 14: _______

COSTS: $150 for one participant

LOCATION: The Balboa Bay Club & Resort 1221 West Coast Highway Newport Beach, CA 92663 (949) 645-5000

DATES AND TIMES: SEPTEMBER 10th & 11th Fri. 4:00pm - 8:00pm Sat 9:00am 2:00pm

PAYMENT: Make all checks payable to 4MT and mail with application to 25896 Vista Drive West Capistrano Beach CA. 92624 Upon receipt of registration and full payment, confirmation will be made by phone or email.

RELEASE FOR MEDICAL TREATMENT Is tetanus shot current?:________ Date if known :___________Allergies:__________________________________ Physical concerns staff should be aware of : _________________________________________________________ I hereby authorize medical treatment for ______________:_____________________________________________ Signature of Parent/Guardian : __________________________________________ Date :________________

PLEASE READ AND SIGN THE FOLLOWING STATEMENT In consideration of the services provided, I hereby release and hold harmless, Emily Greener or i am that girl, and its director, employees and agents from any and all liability for injuries, including those resulting in death, and illnesses incurred while attending workshop or occurring as a result of having attended workshop. I certify that my child is in good health and is able of participate in all program activities. Furthermore, in an event of an emergency requiring medical attention, I shall pay for the services rendered.

Signature of Parent/Guardian: ___________________________________________ Date: _________________