Race/Ethnicity: French Canadian

This Purchaser Semen and Storage Agreement (“Agreement”) is entered into between Copenhagen Sperm Bank (CSB), and the undersigned patient of products and services provided by CSB and, if applicable, her partner or spouse (collectively “Purchaser”).

1. Donor Semen.

CSB sells donated semen (“Donor Semen”) that is tested and screened for certain genetic and infectious diseases. To assist Purchaser in the selection of Donor Semen, CSB provides a variety of information and materials about the donor and the testing process. Purchaser agrees that all such information is for Purchaser’s private use and not for public dissemination and that Purchaser is solely responsible for the selection of Donor Semen.

In the cases where donors have had Genetic Carrier Screening performed, the test results will be available at no charge so that a potential purchaser can review should any positive result exist. Extended genetic screening is only performed at the discretion of CSB. Any donors that carry mutations screened for in the Genetic Carrier Screening will require the purchaser to fill out an informed consent for use of said donor. CSB will make available more information upon request regarding any positive carrier status.

2. Purchase of Donor Semen.

Orders for Donor Semen may be made only through CSB’s website, by telephoning CSB’s laboratory, or through any of CSB’s consignment tank programs with our partners. Payment must be made in full at the time an order is placed. All purchases are final and there are no refunds or exchanges except as otherwise set forth in this Agreement. Upon purchasing Donor Semen, Purchaser must either arrange for storage by CSB (see Section 3) or arrange for shipping to an alternate location (see Section 4). Purchaser is solely responsible for all costs related to CSB Donor Semen, including shipping charges and all charges related to or arising out of any treatment with Donor Semen.

3. Storage of Donor Semen.

CSB provides storage services at our laboratory for Donor Semen purchased from CSB. Available storage periods range from 1 month to 10 years. Payment for storage must be made in full in advance of the commencement of the storage period. Prior to expiration of the storage period, Purchaser must elect to contract for a new storage period, request in writing that Purchaser’s Donor Semen be destroyed at the conclusion of the storage period, or request shipment of Purchaser’s Donor Semen to another location (shipping and handling costs will apply). Purchaser may also request that Donor Semen purchased from CSB and stored by CSB be bought back by CSB. Repurchases may or may not be accepted, at the sole discretion of CSB, and subject to applicable fees imposed by CSB. If Purchaser fails to pay storage fees for a period of 30 days, all such Donor Semen will become sole property of CSB, to re-sell, destroy, or retain for future use CSB will attempt 4 email and 4 phone call attempts before the reclaiming of Donor Semen during this 30-day period. All requests for storage extensions must be in writing or with proof of purchase showing storage extension.

4. Release of Donor Semen.

Except as set forth in Section 5, CSB will release Donor Semen to Purchaser, Purchaser’s health care provider, or any person designated by Purchaser in writing to receive Purchaser’s Donor Semen; provided that, written permission from Purchaser’s health care provider is required before CSB can release Donor Semen directly to Purchaser, to another person designated by Purchaser, or to a non-clinical address. At the request of Purchaser, CSB will ship Donor Semen via a commercial shipping service. In the event shipment is requested, Donor Semen shall be deemed delivered to Purchaser upon acceptance by the shipper for shipping and Purchaser shall accept all risk of loss to Donor Semen during shipping. CSB will not be responsible for any damage or loss to Donor Semen or any delay that may occur after Donor Semen leaves CSB’s facility. Purchaser shall pay all shipping and handling charges.

5. Changes Restricting or Preventing Donor Semen Release.

Changes to donor screening requirements or the discovery of new medical or genetic information about a donor may restrict or prohibit the release of Donor Semen. In the event CSB is unable to release Donor Semen to Purchaser for these reasons, CSB will provide Purchaser with a full refund for Donor Semen that cannot be released. In the event of a refund, Purchaser may elect to purchase additional Donor Semen at then current per vial rates.

6. Quality of Donor Semen.

Purchaser understands that, in most circumstances, approximately 20 million motile sperm/mL will result from every post-thaw IUI sample (0.5 mL) of Donor Semen and 15 million motile sperm/mL from every post-thaw ICI sample of Donor Semen. However, there can be cases where fewer motile spermatozoa are present. If Purchaser’s health care provider confirms in writing that a significantly lower number has occurred and, as a result Purchaser’s treatment has been cancelled, and if the deviation is not related to damage during transport or improper handling of the Donor Semen after release by CSB, CSB will provide, at no additional charge to Purchaser, replacement samples from the same donor, if available, or from a similar donor if the original donor is no longer available. CSB will not be held responsible for any reimbursement of any missed procedures, medical travel, medications, or any other costs related to the treatment with Donor Semen.

7. Treatment with Donor Semen.

Purchaser will direct any questions regarding treatment with Donor Semen and limitations and risks associated with using Donor Semen to their treating physician or other health care provider and acknowledges that CSB has no responsibility to provide such information. CSB is not responsible in any manner and makes no representation or warranty related to the treatment process or risks or limitations.

8. Reporting Pregnancies.

Purchaser agrees to report all pregnancies and pregnancy outcomes (miscarriages, births) arising out of the use of Donor Semen purchased from CSB. Pregnancy and all pregnancy outcomes shall be reported by the Purchaser or the Purchaser’s health care provider. Pregnancies shall be reported no later than sixty (60) days following completion of the first trimester. Purchaser understands that if a birth is not reported to CSB, no release of donor identity information and/or contact between donor and donor offspring may occur (at, or after, the age of 18 of donor offspring).

9. Protection of Donor Identity.

Purchaser agrees that Purchaser has no right to learn the identity of a donor and will not, directly or indirectly through a third party, make any attempt to contact a donor. Further, CSB will not disclose identifying donor information or assist Purchaser in any way to contact a donor. In the event CSB discovers that Purchaser is attempting to identify a donor by other means, CSB will take all appropriate action to protect the anonymity of the donor. Notwithstanding the foregoing, all donors at CSB may sign an open donor contract. When a child born from an open donor turns 18, the child may apply to CSB to obtain contact with the donor. CSB does not provide this information to anyone other than a child and only after the child has turned 18. While donors sign open donor contacts, CSB cannot guarantee that all efforts to arrange contact with a donor will be successful.

10. Protection of Purchaser Identity.

The Health Information and Portability Protection Act of 1996 (the Privacy Rule) grants Federal protection from the unnecessary disclosure of your personal health information. The Privacy Rule requires healthcare entities to maintain the confidentiality and protection of your personal medical information. However, it may be necessary for CSB to communicate your identification and treatment information among your healthcare providers. I/We understand that by releasing personal identification information to an organization that may not be a health care organization or a health care provider this information may be re-disclosed by them and may no longer be protected by federal privacy laws.

In order to remain in compliance with the Privacy Rule, your expressed, written consent is required prior to your disclosure of your protected health information. This Agreement grants permission to Seattle Sperm Bank to disclose your personal identification information among your healthcare provider(s).

You may revoke this Agreement in writing at any time, except to the extent that action has already been taken. However, revocation of the Agreement may make you ineligible to make future purchases with CSB, and nullify your child’s ability for future Open Donor Contact.

11. Purchasing a Family Slot.

For any CSB donor that is indicated as a "Family Slot Donor", Purchaser understands that it is required to purchase a Family Slot from that particular donor for the us of that particular donor. The Family Slot purchased includes one year of complimentary storage. Family slots do not expire providing Purchaser access to available vials throughout Purchaser's treatment. Purchaser understands that they can only procure a Family Slot from on donor.

If the Purchaser procures a Family Slot...

• A vial of any type must be purchased as well, if there is at least one standard IUI vial available.
• If there is not at least one standard IUI vial available, the purchaser can choose to purchase any other vial type or be placed on the wait list for a standard IUI vial(s).
• If Purchaser chooses to be placed on the wait list, offered vial(s) must be purchased within 7 days of notification. If Purchaser does not purchase vials offered from wait list within 7 days, Purchaser de facto relinquishes Family Slot and is refunded the Family Slot fee in full.
• If Purchaser relinquishes Family Slot, they are eligible to purchase a Family Slot from a different donor. Any exception to this policy will be handled on a case-by-case basis.

CSB reserves the right to audit the Family Slot allocations in cases where a Family Slot has been purchased.

For more information on the Family Slot process, please reference copenhagenspermbank.com/family-slot-faq.

12. No Warranties.

Patient and Patient Partner will initial each item, indicating an understanding of CSB’s disclaimer of warranties:

13. Indemnification.

You agree to indemnify and hold harmless CSB and its affiliates, and each of their directors, officers, employees, agents, representative, independent contractors, customers, successors and assign from and against any claim, loss, damages, liabilities, demands, offsets, causes of action and expenses, including attorneys’ and experts’ fees, arising out of or related to any third party action, proceeding or dispute involving CSB products (including Donor Semen) or services. For the avoidance of doubt, any authorized patient of your Donor Semen and any person who uses Donor Semen that you purchase from CSB shall be considered a third party for purposes of this paragraph.

14. Arbitration.

Except as necessary to obtain immediate injunctive relief, any dispute relating in any way to products or services obtained from CSB shall be submitted to confidential arbitration in Copenhagen, Denmark. Arbitration under this Agreement shall be conducted pursuant to rules established by the Danish Arbitration Act (DAA) 2005, by an arbitrator agreed to by the parties. The arbitrator’s award shall be binding and may be entered as a judgment in any court of competent jurisdiction. The prevailing party in the arbitration shall be entitled to recover all costs for the arbitration, including, without limitation, attorneys’ and experts’ fees.

15. Additional Provisions

a. Purchaser represents that she/he is over the age of eighteen (18) and that Purchaser is purchasing CSB’s products and services for personal use and not for resale or other commercial purposes.

b. The undersigned patient of the Donor Semen understands that she will be the legal parent of any child born using Donor Semen and will be responsible for their support and custody. Purchaser (including patient’s spouse or partner, if applicable) understands that neither CSB nor the donor shall have any legal, moral or ethical obligation of support or custody for children born using Donor Semen.

c. This Agreement constitutes the entire agreement among CSB and Purchaser related to the subject matter contained herein, and fully supersedes all prior or contemporaneous understandings of the Parties. This Agreement may not be modified or amended without prior written consent of the Parties. This Agreement shall be construed and controlled by the laws of the country of Denmark and the parties consent to the exclusive jurisdiction and venue in the courts sitting in Copenhagen, Denmark.

d. This Agreement must be executed by the patient and, if applicable, the patient’s partner or spouse and accepted by CSB before CSB will release any Donor Semen from its facility. CSB reserves the right, in its sole discretion and for any reason, to reject the Agreement prior to release of Donor Semen. In the event CSB rejects the Agreement, it will notify Purchasers of the rejection. Purchasers acknowledge that CSB will retain any fees (excluding prepaid donor semen and prepaid shipping fees) they may have paid to CSB prior to any such rejection and Purchaser shall refrain from any claims against CSB arising out of or in connection with a rejection.

e. By signing this Agreement, you hereby release, discharge and agree to hold harmless all parties to whom it is given from any liability that may arise from the release of your personal health information as authorized above.

f. CSB reserves the right to refuse services to a customer, at the sole discretion of CSB.