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CS Agreement - Portfolio Funding Rider, Lifetime Member

CRYONIC SUSPENSION AGREEMENT − PORTFOLIO FUNDING RIDER

Lifetime Membership

This Rider is attached to the Cryonic Suspension Agreement between

______________________________________________________________________________

currently residing at _____________________________________________________________

(hereinafter referred to as the "Patient") and the CRYONICS INSTITUTE, a Michigan nonprofit corporation (hereinafter "CI").

  1. The Patient has agreed to fund his or her contract by the use of an investment portfolio. This form of funding is acceptable to CI provided the Patient provides CI with quarterly investment account statements showing a balance of at least $30,000 plus cost of local help (where applicable) with CI shown as beneficiary (Transfer on Death). If the patient has balances of $40,000 or more (plus cost of local help) in the investment account with CI as beneficiary of that amount, yearly statements sent to CI will be adequate.
  2. If quarterly or yearly statements have not been provided to CI under the terms of the preceding clause of this agreement, if the patient becomes legally dead on a weekend, evening or holiday, the patient may have to await funding verification before receiving cryonics services — which could risk being straight-frozen rather than being perfused. The patient agrees to the foregoing.

PATIENT (CI MEMBER) _______________________________, dated ______________

Subscribed and sworn to before me this _____ day of ________________________________

Signature of Notary Public _____________________________________________________

Name of Notary ________________________ County and State _______________________

If two witnesses are used instead of a notary, for each witness please show signature, printed name, address, and date:

Witness 1 Signature __________________________________________Date ____________

Printed Name _______________________________________________________________

Address ___________________________________________________________________

Witness 2 Signature __________________________________________Date ____________

Printed Name _______________________________________________________________

Address ___________________________________________________________________

IN WITNESS WHEREOF, the parties have signed this Agreement, which is finally executed at Clinton Township, Michigan.

CRYONICS INSTITUTE: by _________________________________________________

It's Contract Officer, dated ___________________


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