TRANS TIME Emergency Responsibility
Enrollment Form

To enroll for TRANS TIME Emergency Responsibility service, please provide the following information. Be sure and read carefully then sign the Limitations of Responsibility and Hold Harmless Agreement. We cannot accept your application without your signature. Make out a check for the appropriate amount and send it along with your signed application to TRANS TIME, 3029 Teagarden St., San Leandro, CA 94577.

Please enroll me for TRANS TIME Emergency Responsibility service.



City, State, Zip__________________________________________________________

Phone number__________________________________________________________

I enclose a check in the amount of (check one):

___ $96 for one year's service, as a first family member, or

___ $48 for one year's service, as an additional family member, or

___ Other: ____________________________________________________________

Limitations of Responsibility and Hold Harmless Agreement

TRANS TIME agrees to provide Emergency Responsibility service as described above, provided the Donor remains a subscriber in good standing by timely payments. Payment terms are Net 30 Days, with past due invoices charged 1.5% per month interest. Charges for Emergency Responsibility are invoiced yearly in advance. TRANS TIME's responsibility ceases with expiration of the payment term if we do not receive further timely payment.

I direct the executor of my estate, or my trustee if I have established a cryonics research trust, to pay TRANS TIME for any services covered by this agreement that are not fully paid by any deposit I may have with TRANS TIME.

I understand that TRANS TIME has no responsibility for my cryonic suspension until I have completed all required legal documents and provided the needed guaranteed funding.

I realize that the treatment of cryonic suspension is new, unproven, experimental, and involves unforeseeable medical and technical problems. This treatment is not consistent with contemporary medical or mortuary practice. I realize that any expectation regarding the possibility of restoring a suspended person to life and health at a future date is based upon pure and hopeful speculation as to the capabilities of future medical science.

Therefore I, my heirs, assigns, and all persons claiming through me, shall hold TRANS TIME, its directors, officers, members, hirelings, agents, and any companies, corporations, or institutions that it may contract with, free from all liability concerning their actions in carrying out the purposes of this agreement.

TRANS TIME uses trained personnel with a wide variety of skills to place and maintain patients in cryonic suspension. Some, but not all, of these persons are licensed by the State in various medical fields. TRANS TIME and colleagues have largely created the current state of the art in cryonic suspension. But at present there exists no government licensing procedure for certifying cryonic suspension personnel.

I have read the above Limitations of Responsibility and Hold Harmless Agreement and agree to these terms.

________________ ________________________________________________
Date Signature


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