Church of Scientology Flag Service Organization (hereinafter referred to as "the Church") Attestation regarding the Scientology Religious Film Called "Orientation" 1. On _________, 20__, I,____________saw the Scientology religious film called "Orientation at the Church of Scientology __________ (hereinafter "the Church"). 2. Having seen "Orientation," and in the exercise of my own free will and my own independent thought and judgment, I recognize, acknowledge and agree that: a. I am exclusively responsible for my present and future condition in life and for the choices and decisions I make affecting my life. ________ b. Scientology is a religion, the Church is a church of the Scientology religion. ________ c. The beliefs, teachings, practices and services of the Scientology religion are exclusively religious in nature, and are set forth in the writings and spoken words of LRH on the subjects of Dianetics and Scientology published with the identifying S and double triangle or Dianetics triangle symbol, and all services or application of the principles of Mr. Hubbard provided to me by the ministers or staff of the Church and all other Scientology churches and organizations, including without limitation: "auditing," which is Scientology's unique form of religious counselling encompassing all services on the Scientology Classification, Gradation and Awareness Charts which includes, without limitation, all levels, rundowns, grades, assists, reviews, repairs, seminars, co-audits; all Scientology congregational services of any description: "training," which is the study of the scripture of the Scientology religion on the road to achieving spiritual freedom and salvation and includes without limitation all services identified on the Scientology Classification, Gradation and Awareness Chart, all courses, internships and cramming; the application of Scientology Ethics and Justice technology, which are both exclusively religious components of the practice of the Scientology religion; the study and the application of the principles contained in the administrative writings of LRH used within the Church, and any and all other services or use of the technology of L. Ron Hubbard, without limitation provided to me by the ministers or staff of the Church and all other Scientology churches and organizations. ________ d. The Church and all other Scientology churches and organizations which espouse, present, propagate or practice the Scientology religion are each separate, distinct legal corporations, and that each such entity is independently responsible for its own management and is independently responsible for its own corporate and ecclesiastical affairs. ________ DATED this ___ day of _______, 20___ ________________________________________________________________ (SIGNATURE) ________________________________________________________________ (Printed Full Name ________________________________________________________________ (Home Address) ________________________________________________________________ (SIGNATURE OF WITNESS) ________________________________________________________________ (Printed Full Name)