1013 Centre Road
     Suite 301
     Wilmington, Delaware 19805-1297

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     1.  I, ________________________________________________, now residing at

declare that I am _____ years of age, of sound mind and memory, and that it is
my wish that upon my death, my human remains be preserved by the treatment
known as cryopreservation.

     2.  For this purpose, and in accordance with the laws governing anatomical
donations, I hereby direct that upon my legal death my human remains be
delivered to the CryoCare Foundation (CryoCare), a Delaware Corporation,
having its principal office and place of business at 1013 Centre Road,
Suite 301, Wilmington, Delaware 19805-1297, or to its agents or
representatives, at such place as they may direct.

     3.  I further direct that, when and where possible, such delivery shall
take place immediately after my legal death, without embalming or autopsy.

     4.  I further declare that I have not received any remuneration whatsoever
in connection with this donation of my human remains, and that I have made this
donation for the purpose of furthering cryobiological and human
cryopreservation research.

     5.  I understand that this action gives CryoCare full and complete control
of my human remains.

     6.  I understand that human cryopreservation is not consistent with
contemporary medical or mortuary practice.  As stated in the other forms which
I have executed with CryoCare, I understand that there are no guarantees or 
any known probability that the procedure of human cryopreservation will be

     7.  If a legal challenge is raised to this Authorization of Anatomical
Donation, I authorize CryoCare to take custody of, and have full and complete
control over, my human remains by whatever legal means may be available for
the purpose of cryopreserving them.  If a legal challenge to this procedure is
raised by any institution, individual(s), or government agency, I authorize
CryoCare to use monies from my Cryopreservation Funding to pay for the legal
expenses involved in defending its authority and ability to cryopreserve my
human remains.

     8.  In witness thereof, I hereby sign, publish, and declare the above,
in conjunction with my Cryopreservation Agreement and my Consent for
Cryopreservation to be my last wish and instruction concerning the disposal
of my human remains following my legal death.

     _________________________          ______________________________
     Signature of Donor                 Responsible person if Donor is
                                        unable to sign or is an unemancipated
                                        minor or otherwise incompetent.


     __________________(a.m./p.m.)      ______________________________
     Time                               Relationship to Client


     Two (2) witnesses are required to sign in the
presence of each other and the Donor.  At the time of
signing, witnesses must not be relatives of the Donor, health
care providers of any kind, or officers, directors, or agents
of CryoCare.


     1. You have witnessed the signature of the Donor on this document.

     2. The Donor has represented to you that s/he understands and agrees to
the purposes and terms of this document.

     3. The Donor has declared to you that the arrangement described herein,
in conjunction with his/her Cryopreservation Agreement and Consent for
Cryopreservation constitutes his/her last wish as to the disposition of
his/her human remains after legal death.

     WITNESSED THIS _______ DAY OF _____________________, 19__________
     TIME ______________(a.m./p.m.)
     1. Signature             ____________________________________________
        Printed               ____________________________________________
        Address               ____________________________________________

     2. Signature             ____________________________________________
        Printed               ____________________________________________
        Address               ____________________________________________