CS Agreement - Yearly Membership Rider
CRYONIC SUSPENSION 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 ___________________