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Diversity Bread ®

Good for your gut & good for the environment

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Diversity Bread Licensing Application Form

This is a digital submission form for licensing Diversity Bread, made in accordance with the Baking as Lifestyle Medicine (BALM) Protocol.

Before You Begin: Key Requirements

To qualify for your formula to carry the Diversity Bread™ license, please use this quick check that your bread meets the following criteria:

☐ I am an artisan or microbakery (not a supermarket or factory)
☐ I bake with a live sourdough starter (not commercial yeast)
☐ My Diversity Bread® ferments for at least 18 hours
☐ I use at least 20% Botanical Blend™ flour in each licensed loaf from a registered mill
☐ My flour is glyphosate-free (preferably regenerative or organic)
☐ I understand and follow the Principles of The BALM Protocol
☐ I will include a QR code on every Diversity Bread® product to educate my customers
☐ I will not make health claims (except where approved for Proven Bread™ )
☐ I agree to pay the correct licence fee based on my production volume
☐ I understand this licence protects artisan bread from industrial misuse

Please note that if in a food establishment If served in a restaurant, café, or food business, bread must be paired with a fermented or probiotic-rich accompaniment (e.g., cultured butter, live yogurt, kimchi) in accordance with the key principles of the BALM Protocol.

By submitting this form, you confirm that your bread aligns with these requirements.

Application Form

Diversity Bread Licensing Application Form

Section 1: Applicant Information

Maximum file size: 16.78MB

Section 2: Bread Submission

Does your bread contain at least 20% Botanical Blend Flour?

List all flours used and their percentages:

Organic/Regenerative
plus1 Add minus1 Remove
Organic/Regenerative
plus1 Add minus1 Remove

Maximum file size: 2MB

Section 3: Hydration & Bread Type

Bread type

Section 4: Serving & Pairing (For Food Establishments Only)

Will this bread be served in a restaurant, café, or food business?
If yes, select the accompanying fermented/probiotic-rich food

Section 5: Additional Information

Section 6: Declaration & Agreement

I confirm that this bread meets the Diversity Bread™ requirements, including: *
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