Health Care Investment Conference

A. I currently hold (or am now in the process of opening) an account with IRA Club.
B. The designated third party on this form may seek information regarding the above-captioned account.
C. The designated third party may not transfer funds, transfer assets, or authorize investment transactions on behalf of the account owner.
D. I now and forever hold harmless and release IRA Club and its employees for any and all errors in the execution of this agreement. I further understand and agree that IRA Club and its employees cannot be responsible for all actions that a third party may take.
E. I understand disputes may arise from this agreement. IRA Club will settle disputes in Cook County, Illinois, and that the laws and regulations of Cook County, Illinois shall apply.
F. Separation: I understand the IRA Club is an independent company and is not related to the third party.