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