BodyGem®/MedGem® Locator Release Form

The primary purpose of the BodyGem/MedGem Locator feature on the Microlife Website is to provide quick and easy access to a publicly available list of facilities and providers that offer metabolism measurement services. Listing your company or name in this Web-based public directory is an effective way to reach this targeted audience and to grow your customer base. By completing and signing this form, you hereby request to be included in the BodyGem/MedGem Locator list and you agree to the following terms:

1.By requesting to be included in Microlife’s Gem Locator, you give Microlife, Inc. the right to use your company's or other entity’s name (as provided by you below) and related contact information on its Web site, and in written copy that may be created in connection therewith, and acknowledge that your listing in Microlife’s BodyGem/MedGem Locator or other published listings is at the sole discretion of Microlife, Inc.;

2.You agree that the contacts you receive from the information provided on Microlife’s Gem Finder will not be used for any other pupose than the solicitation of potential clients for metabolic reading services. You will not engage in the resale of Microlife’s device or single-use mouthpieces/masks outside of your own use of the products in completing reading services.

3.You agree that in consideration of being listed on Microlife’s Web site, you will only purchase devices or single-use mouthpieces/masks from an authorized Microlife distributor, or direct from Microlife, Inc.

4.All information provided herein shall be deemed to be non-confidential and Microlife, Inc. shall have no obligation of any kind with respect to such information and shall be free to reproduce, use, disclose and distribute the information to others without limitation;

  1. You agree to update your contact information promptly to Microlife, Inc. upon any changes becoming effective;
  1. You agree to notify Microlife, Inc. in writing immediately upon your election to no longer offer BodyGem/MedGem metabolism reading services so that Microlife can remove your contact information from the listing, and you hereby request and authorize Microlife, Inc. to do so upon receipt of such notice;
  1. You agree to offer any BodyGem/MedGem metabolism reading services in full compliance with the written instructions for use which accompanied the device; and
  1. You acknowledge that you are not providing any relevant services as an agent of Microlife, Inc., nor an employee of Microlife, Inc., and you shall not hold yourself or any affiliated company out as an agent or employee of Microlife, Inc. and that Microlife, Inc. does not endorse, control or otherwise certify the services you may provide.

Note: In some cases, it may take up to two weeks for your location to appear in the BodyGem/MedGem Locator.

Please indicate how you would like your listing to appear:

Corporate Affiliation or Company Name (This will be the first line of your listing):

Location Name or Contact Name (This will be the second line of your listing):______

Street Address:

City, State, Zip:

Telephone: ______Email Address: ______Web Address:

I hereby agree to the above terms.

Signature:

Print Name:

Date:

Confidential and Proprietary. Disclosure, reproduction or distribution of these materials by the recipient is expressly prohibited without prior written authorization from Microlife Medical Home Solutions, Inc. 2801 Youngfield St, Suite 241

Golden, CO80401

303-274-2277 Phone

303-274-2244 Fax

FRM-19-01-G