MHM - Mobile Health Management Version 3.01 Simply Unlimited Business Services (S.U.B.S.) 2318 Plateau Ct. Kingwood, TX 77339-2951 (281.734.0602) e-mail to: subslef@ev1.net -------------------------------------------------------------------- REGISTRATION CODE APPLICATION: I understand the following information is provided to S.U.B.S. in strictest confidence and none of this information will be provided to any other organization, person, business, etc. for any reason. I will expect to receive only calculated results from using MHM based on the user profile information I enter into the MHM Profile form. Any errors in this entered information will be solely my responsibility to correct and manage. I agree to work closely with my physician and regularly review the results of all calculations and information provided through my use of MHM. I will make all adjustments advised by my physician to my profile to improve the calculated results of MHM for my treatment. I agree to not hold S.U.B.S. nor their assignees responsible for my failing to follow any of my physician's directions. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - My User Name: - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - My e-mail address: - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - My street address: - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - My city name: - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - My state: - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - My Postal zip code: - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - If anyone referred you to MHM, they are entitled to a reduction in their next 'add-on' or a free one year's subscription to the annual update service. Please supply their current e-mail address below. Referral e-mail address: - - - - - - - - - - - - - - - - - - - - - - - Your registration code will be provided by S.U.B.S. within 48 hours once your e-mailed information is received at subslef@ev1.net BE CERTAIN your spelling and info is correct before e-mailing - Your registration code will only work if the information matches the MHM-user profile you enter on your Palm computer once you have your registration code. Thank you for making the decision to use MHM to assist you in your diabetic management and control.