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    Date                  Month/Day of Birth                    Printed Name                                                   Signature

Consent and Release Form: Your personality and character may be analyzed through the science of graphology by S. A. Petullo Corporation.  Graphology is a science and decades of research have shown graphology to be a valuable, nondiscriminatory method to evaluate human personality traits.  Graphology can display, among other things, a person’s talents, desires and abilities.  By signing above, I hereby release S. A. Petullo Corporation and its associates of any liability based upon their findings or recommendations.   Handwriting Sample Instructions: 1. Relax and use your natural handwriting.  If you normally print, please include a minimum of one paragraph of cursive writing.   2. Please explain above any physical limitation that affects your handwriting.  3. Use a ballpoint pen and sign your name at the end.  4. Please answer the following questions in your own handwriting.  Write a minimum of one page and feel free to continue writing on the reverse side of this page.  What would you like to accomplish over the next year?  What special qualities do you have that will help you achieve your goals? What other qualities would you like to develop further?