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").

In the event that CI does not commence or does not continue the Patient's cryopreservation, pursuant to the provisions of this Agreement, and CI possesses or receives part or all of the Cryopreservation Fee through payment under the Patient's life insurance policy, trust agreement, or otherwise, any portion of the Cryopreservation Fee to which CI is not entitled shall be distributed as specified and initialed below [choose ONLY ONE of (1) to (4) by initialing your choice]

(1) ______ (initials) I, the Patient, give the Cryopreservation Fee funds as a donation to CI

If choosing this option, you may want to be more specific about how CI is to use the funds.
(If so, initial one ONLY)

_____ Research ______ Prepayment for needy CI Members _____Where most needed

(2) ______ (initials) I, the Patient, give the Cryopreservation Fee funds as a prepayment for
cryopreservation at the Cryonics Institute for the following person:

Name _________________________________________________________________

Address __________________________________________________________________

_________________________________________________________________________

Relation to Patient ________________________________________________________

OR

(3) ______ (initials) I, the Patient, give the Cryopreservation Fee funds to the following person

Name _________________________________________________________________

Address __________________________________________________________________

_________________________________________________________________________

Relation to Patient ________________________________________________________

OR

(4) ______ (initials) I, the Patient, give the Cryopreservation Fee funds to my estate, to be distributed in
accordance with the provisions of my last will and testament.

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 ___________________