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Blue Zones Your Privacy Choices

Please use this form if you wish to submit a request related to your personal information stored and managed by Blue Zones, LLC (“Blue Zones”) in accordance with certain privacy rights you may have as a resident of California, Nebraska, or Texas. Please do not submit this form unless you are a resident of California, Nebraska, or Texas. For more information about your data rights, please visit our Privacy Policy.

Please note that in order to keep your data secure, if you are unable to provide information sufficient to identify yourself and verify your request, the request may not be considered complete, and you will be notified of that determination. Please note that you can only submit one (1) request at a time. Therefore, each request type will need to be submitted individually.

[Questions with an * are required]

Your Privacy Choices

Fill out the form to submit your privacy choices.

Please select your state of residence below:
Relationship to Information - I am submitting this request on behalf of:
Relationship to Blue Zones - I, or the individual I am submitting this request on behalf of, am/is a/an:

Contact Information

If we cannot confirm your identity using the information you provide below, we will contact you for additional information. If we are unable to verify your identity, we may be prohibited from fulfilling your request.
Name

Parents or Guardians

I am a parent or legal guardian (only select “YES” if you are submitting this request on behalf of a minor child for whom you are the parent or guardian). A member of our team will contact you to verify that you are the parent or guardian of the child identified.

Authorized Agents

I am an Authorized Agent (only select “YES” if you are submitting this request as an Authorized Agent for someone else). An “Authorized Agent” is a legally authorized agent that an individual has authorized to act on their behalf for submission of this request. A member of our team will contact you to provide proof of authorization to act on the individual’s behalf.
Acknowledgement