This account submission form is for clients only. If you are a staff member of a client, please contact your office administrator to provide you access to our system. If we receive account requests from this form that are not from approved clients, you account request will be denied. 1 2 Terms and ConditionsBy requesting an online account from healthyhabitsmc.com and requesting Healthy Habits Management Company, Inc. (HHMC) to accept its application to be considered to become a client/licensee, applicant and any of its agents, directors, employees, managers, members, officers, proprietors and shareholders (if closely held) hereby agrees, if its application is granted, to be bound by and adhere to the following terms and conditions, and hereby acknowledges this by continuing to submit its application. In consideration of the subject License, and permission to use the copyrighted materials, manuals, protocols, policies and procedures, Licensee, and all Its agents, directors, employees, managers, members, officers, proprietors and shareholders, (if closely held) (the "Licensee Affiliates"), agree to practice the Healthy Habits Complete Medical Weight Loss System (the "HHCMWL System") only according to the License, and only during the term of the License, and in no other manner. Upon termination of the License, or independently beyond the License, either before, during or after the term of the License, Licensee and Licensee's Affiliates all agree that no one is permitted to practice the HHCMWL System, nor copy, nor distribute any HHCMWL System manuals or other written material, and any such unpermitted practice or copy or distribution has been, is or will be a breach of the License by Licensee as well as by any particular offending Licensee Affiliate, and has been, is or will be specifically also a breach of this non-compete provision. Licensee and Licensee's Affiliates all agree that the subject HHCMWL System and materials contain, embody and comprise valuable trade secrets, technique and know how, and any actual or imminent or threatened breach of this non-compete provision may be enjoined by a US Federal or Idaho State Court in Boise, Idaho with attorneys' fees and costs awarded to Licensor, Healthy Habits Management Company, Inc. (HHMC). Furthermore, Licensee and Licensee's Affiliates all agree to be individually and personally liable to HHMC for any breach of this non-compete provision, and hereby subject themselves to the personal jurisdiction of said US Federal or Idaho State Court for resolution of any claim by HHMC about any alleged breach by them of the License Agreement or this Non-Compete Provision.Terms and Conditions Agreement*By checking the box below, you agree to the Terms and Conditions setforth above I agree to the Terms and Conditions Name:* First Last Company Name:*Email:* Enter Email Confirm Email Primary Shipping Address:* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Subscription: Receive periodic news and updates Security Code:Please type the text you see in the field.