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CS Agreement - Yearly Membership Rider


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").

The Patient joined CI as an "Yearly Membership" member; the membership application is attached hereto for reference. It is acknowledged by the Patient that all duties of CI under the Cryonic Suspension Agreement shall have as a Condition Precedent the full and timely payment of Yearly Membership Dues by the Patient to CI.

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 ___________________