Until I say EVERY DAY that I have my legal notification, I DON'T HAVE IT. Don't give it to ANYONE ELSE.

IDENTITY JOURNAL PRE-ORDERS

DON'T TRUST YOUR IDENTITY TO HUNDREDS OF BILLS AND INFORMATION CRAMMED INTO A DRAWER. My Identity Journal is ready to be pre-ordered for $12.95 each. Almost a hundred categories will keep all your information in an orderly notebook that you keep in your safe deposit box. Each member of your family can keep their own journal with all identifying information in a safe place.

Consent to Release Medical Information

CONSENT TO RELEASE MEDICAL INFORMATION 

Expires: _________________________________________  

Patient Name: _______________________________________ Date of Birth: ______________  

Address:  

______________________________________________________________________________ 

______________________________________________________________________________ 

II. WRITTEN CONSENT SECTION  

I, _______________________________________________ hereby consent to the release of the following information from my medical records by __________________________ 

to ________________________________________________ at the following address: _____________________________________________________________________  

Specific Information to be Released:  

______________________________________________________________________________  

Specific Purpose of Release:  

______________________________________________________________________________  

This written consent is subject to revocation at any time by writing to the physician or practice which is to release the information except to the extent that this physician or practice has already acted in reliance on this consent. With the exception of mental health, HIV-related information or drug &/or alcohol abuse records, once your health information is disclosed, it may be re-disclosed by the recipient and may no longer be subject to state or federal law protections. To revoke this consent, simply sign and date the revocation section on your copy of this form and return it to your physician’s office or, if this authorization is for research, to the Principal Investigator (PI), the primary researcher conducting the study. If you do not have a copy, another copy will be provided. If not previously revoked, this consent will remain in force from ___________________________to___________________________________ the end of which consent expire.  

REVOCATION SECTION(to be completed and signed by the patient):  

This consent expires on (00/00/00):________________________________________________  

Fighting the War for the Atmosphere

1. No blue rooms and accountability with bonding issues for public officials and lawyers including a formal, public investigation into the allegations that 5000 American citizens are dying each week at the hands of aggressors with electromagnetic frequency weapons (EMFW).

2. Notification and protection of victims of organizational harrassment or targetting including sexual harassment and assault, identity theft, EMFW targeting, impersonators and look alikes, subliminal targetting and others, according to the Patriot Act.

3. Removal and strict accountability of electromagnetic frequencies used as weaponry, especially in public places and residences.

4. Prosecution of answering services which waylay 911 calls and even government, business and personal calls.

5. Informing public safety sighters of nuclear vortexes and the problems with power fields.

6. Advocacy for the planet and acknowledgement that the Ozone layer is in danger and is vital for the survival of the Earth's inhabitants & THAT TRILLIONS OF GALLONS OF OUR H2O IS FLYING OUT INTO THE SOLAR SYSTEM, NEVER TO RETURN.

7. NO casual sexual activity. NO prostitutional favors. NO significant other relationships outside of a strong network with a commitment.