Download the waiver form - Susan Samueli Center for Integrative 2025

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering your name in the 'Participant’s Name' field. Ensure you print legibly for clarity.
  3. Next, provide your daytime phone number and email address in the respective fields, making sure they are accurate and easy to read.
  4. Review the waiver of liability section carefully. This outlines the risks associated with participation. Acknowledge that you understand these risks before proceeding.
  5. In the 'Signature of Participant' section, sign your name to confirm your agreement with the terms outlined in the waiver.
  6. If applicable, a parent or guardian must sign in the designated area for minor participants, along with their age.
  7. Finally, ensure all required fields are completed before submitting to avoid delays in enrollment.

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As the namesake for the Susan Samueli Integrative Health Institute, Susan Samueli is following her passion for providing health solutions. In this video, she explains how integrative health incorporates integrative and conventional modalities to identify and treat the root causes of chronic health issues.
Susan Samueli was born and raised in Los Angeles. She earned her bachelors degree in Mathematics from UC Berkeley in 1972.
Samueli has received numerous awards including the University of California, Irvine Medal in March 2000, the 2002 Ellen Cooperman Angel Award from the John Wayne Cancer Institute, the 2005 General William Lyon Crystal Vision Philanthropy Award from the Orangewood Childrens Foundation, the Individual Award from the