CryoLife, Inc. (“CryoLife”) is requesting your consent to include your name, business address and business phone number, website, email, and the procedures that you perform (the “Information”) for use in certain CryoLife marketing and educational materials, and other general commercial and business materials, including CryoLife web pages (the “Purpose”), specifically the Heart Valve Choice On-X Surgeon Finder (the “Surgeon Finder”) found on CryoLife’s website, www.HeartValveChoice.com.

By submitting any information to CryoLife for the Surgeon Finder, You represent and warrant that You implant or perform (select all that apply):

If indicating You perform Minimally Invasive Surgery with On-X Prosthetic Heart Valves, You represent and warrant that:

• You have expertise in conventional aortic and mitral valve replacement surgery;
• You perform 30 or more aortic and/or mitral valve-related replacement surgeries per year;
• You perform 10 or more minimally invasive aortic valve replacement surgeries per year; and
• You perform 10 or more minimally invasive mitral valve replacement surgeries per year.

By submitting form, you acknowledge and agree that no one has made any promises or statements to you in order to induce you to grant CryoLife such permission, and that you do not expect to be compensated in any fashion for the use of your Information for the Purpose. As such, you agree to waive and release all claims, rights, title and interest to any and all proceeds and revenues derived from the use of the Information and agree that all proceeds and revenues are the sole property of CryoLife. Furthermore, you acknowledge that you have been authorized by your employer and/or the entity at which your practice is located to include its name in your business address for the Purpose.

Additionally, you hereby expressly and voluntarily release and discharge CryoLife, its principals, officers, agents, employees, licensees, successors and assigns from and against any and all claims that you now have, or may have in the future, for invasion of privacy, defamation, right of publicity or any other cause of action purportedly arising out of CryoLife’s use of your Information for the Purpose. You have the right to request the removal of your Information from CryoLife materials at any time. A removal request should be sent to info@heartvalvechoice.com. CryoLife also has the right to remove or not use your Information. You authorize CryoLife to update your Information when applicable (e.g. address change).

If you agree to the terms and requirement criteria stated here within, and give your consent for the Purpose, please acknowledge your agreement by signing in the signature box provided below.