Health Spa Consumer Protection Act {CFD-03}

Name Address(Attach separate list if necessary)Name of Health Spa's parent corporation, if applicable:Street Address: The names and street addresses of all officers, directors and stockholders of the Health Spa's parent corporation are as follows:Name Position Held Address (Attach separate list if necessary)The types of facilities available are as follows: Name, street address and telephone number of a contact person responsible for filing annual registration:NAME (Signature of Contract Person)STREETADDRESS(Telephone Number)ADDRESS: CityStateZIP CFD-03 Rev. 001027021n024030n030007r013027r031n027035025016007031n031r $'#$t 003n026020031025022037004020031031022r006025013021 I understand that knowingly signing a false document with the intent to file with the Arkansas Secretary of State is a ClassC misdemeanor and is punishable by a fine up to $100.00 and/or imprisonment up to 30 days.NOTE:Subsequent annual reports may be filed within thirty (30) days of the anniversary date of this filing.Health Spa Consumer Protection ActAnnual Registration StatementDate:Name of Health Spa:Street Address:The name and addresses of all officers, directors and stockholders of the Health Spa as follows: American LegalNet, Inc. www.FormsWorkFlow.com