Please fill out all mandatory fields in this form to opt out of an arbitration provision. This form is for informational purposes only. An opt-out is valid only if it is submitted in alignment with the specific terms and requirements of the applicable arbitration provision in the QALY Terms of Service. First Name * Last Name(s) * Postal Address * QALY Account Email Address * Statement of Intent * Opt-Out I hereby confirm that I am opting out of the arbitration provision in the QALY Terms of Service (in relation to Section "N"). CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. What code is in the image? * Generate a new captcha Submit
