Legal Opt-In Form

LEGAL OPT-IN FORM

This Legal Opt-In Form (the Agreement) is made and entered into as of by and between Participant Name: (the "Participant"), and Provider Name: (the "Provider"). Participant and Provider collectively are the Parties.

RECITALS

WHEREAS, Provider offers certain legal services, notifications and dispute-resolution options for which Participant may affirmatively opt in; and

WHEREAS, Participant desires to provide a written, express consent to certain communications, dispute resolution procedures, and limited information sharing as set forth below; and

WHEREAS, the Parties intend that this Agreement constitute an enforceable record that evidences Participant's consent and the Parties' mutual obligations with respect to the matters described herein.

NOW, THEREFORE, in consideration of the mutual covenants contained herein and other good and valuable consideration, the Parties agree as follows:

1. OPT-IN ELECTION

Participant affirms the following elections by selecting the options below. Each selection is a separate, binding consent and may carry independent legal consequences.

2. EFFECT OF OPT-IN; REPRESENTATIONS

By providing the consents set forth in Section 1 and executing this Agreement, Participant represents and warrants that Participant is a natural person or an entity with authority to execute this Agreement, and that Participant's election is knowing, voluntary, and made with full understanding of its legal effect. Where arbitration has been selected, Participant acknowledges that arbitration may limit the right to pursue claims in court, including jury trials.

Provider represents that it will rely on Participant's documented consents and will not treat any consent here as a waiver of legal rights except as expressly set forth in this Agreement. Provider's obligations are limited to those expressly stated in this Agreement.

3. SCOPE, LIMITATIONS, AND PROCEDURES

3.1 Scope. The consents granted apply only to the categories of communications and disclosures expressly selected by Participant in Section 1 and only for matters reasonably related to those categories. Nothing in this Agreement authorizes disclosure of privileged communications except to the extent Participant affirmatively authorizes such disclosure.

3.2 Procedures. Electronic notices shall be deemed received when transmitted to the contact information provided in Section 6, unless the sending party receives an automated delivery failure notice. Arbitration, if selected, shall proceed under the neutral arbitration rules agreed at the time a dispute is submitted; procedural details and the designated administrator shall be set out in a separate arbitration agreement executed by the Parties at such time.

4. REVOCATION AND WITHDRAWAL

Participant may revoke any consent provided herein at any time by delivering written notice to Provider in accordance with Section 6. Revocation shall be effective upon receipt, but shall not impair any action taken by Provider in reliance on the consent prior to receipt of the revocation or any rights accrued prior to revocation.

5. CONFIDENTIALITY AND DATA HANDLING

Provider shall use reasonable administrative, technical, and physical safeguards to protect Participant information disclosed under this Agreement. Provider may retain records necessary to demonstrate compliance with applicable legal obligations and this Agreement. Information shared pursuant to Section 1 may be used only for the purposes described herein unless Participant provides additional written authorization.

6. NOTICES

All notices, requests, demands and other communications hereunder shall be in writing and delivered by hand, by certified mail (return receipt requested), or by nationally recognized courier to the addresses provided below or to such other address as either Party designates by notice to the other Party.

7. REMEDIES; INDEMNITY

Each Party retains all remedies available at law or equity for breach of this Agreement, including injunctive relief. Participant agrees to indemnify and hold harmless Provider from and against any third-party claims arising from Participant's misrepresentations, unauthorized disclosures, or misuse of consents granted under this Agreement, except to the extent such claim results from Provider's gross negligence or willful misconduct.

8. GOVERNING LAW; ENTIRE AGREEMENT; SEVERABILITY

8.1 Governing Law. This Agreement shall be governed by and construed in accordance with the laws of the jurisdiction selected by the Parties below without regard to conflict of law principles.

8.2 Entire Agreement. This Agreement constitutes the entire agreement between the Parties with respect to the subject matter hereof and supersedes all prior understandings, agreements and communications, whether written or oral.

8.3 Severability. If any provision of this Agreement is found to be invalid, illegal or unenforceable, the remaining provisions shall remain in full force and effect and the invalid provision shall be reformed only to the extent necessary to make it enforceable.

9. AMENDMENTS; WAIVER; COUNTERPARTS

Any amendment or modification of this Agreement must be in a writing signed by both Parties. Failure to enforce any provision of this Agreement shall not constitute a waiver of future enforcement. This Agreement may be executed in counterparts, each of which shall be deemed an original and all of which together shall constitute one instrument.

10. ACKNOWLEDGMENT AND CERTIFICATION

By signing below, Participant certifies that Participant has read and understands the terms of this Agreement, that the consents selected are deliberate, and that Participant has received adequate opportunity to ask questions and obtain clarification prior to execution.

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