Foreign Funds Rider - Annual Membership
CRYONIC SUSPENSION AGREEMENT – “FOREIGN FUNDS” RIDER Yearly 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 $37,000 U.S., CI may require that the Patient increase funding to the equivalent of $42,000 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 ______________________