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Foreign Funds Rider - Lifetime Membership

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”).


            The Patient has agreed to fund his or her contract in funds other than U.S. dollars.  This is acceptable to CI, provided that if, at any time, the value of the funding provided or agreed to by the Patient declines in value below $30,000 U.S., CI may require that the Patient increase funding to the equivalent of $35,000 U.S.  Patient agrees to the foregoing.


PATIENT _________________________________________ 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, social security number, 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 ______________________