How would you describe your current perception of the MDVIP model and organization? 

Which of the following challenges do you believe MDVIP could help address? (Select all that apply)

What is your biggest hesitation or concern about the MDVIP model at this point? 

Please indicate the topics that most interest you at this stage in your exploration of MDVIP:

Will you attend all meals?

Your Friday Plated Dinner Selection

 Please select one option:

I consent to MDVIP, LLC, including its affiliates and related entities and its agents, employees and representatives (collectively, “MDVIP”) recording me, including but not limited to photography, video, and audio or digital recording (collectively, “Recordings”). I agree that MDVIP will own all Recordings. I authorize MDVIP to copy, exhibit, publish, or distribute Recordings and any information derived from those Recordings, and to edit those Recordings as MDVIP believes is necessary, provided that such editing does not materially change the information I provide. I agree that MDVIP may use the Recordings for purposes of publicizing MDVIP programs or marketing MDVIP services to others, for any other legitimate marketing or promotional purposes, or for any other purpose MDVIP deems appropriate. I agree not to share any information that I do not want disseminated to the public.