Champion Health, Inc. (“CHI”) has prepared legal resources for the specific, limited purpose of analyzing the legal and compliance aspects of the CHAMP Plan. Such resources are and must remain confidential. CHI legal resources may not be distributed or shared for any marketing purposes.

The undersigned hereby acknowledges and agrees that the document requested above and any related passwords will only be used for the above-described purpose and will only be shared with the above-listed party.

In the event the undersigned wants to share the document and/or password for any other purpose and/or with any other party, the undersigned understands and acknowledges that the undersigned must prepare and execute a new request.

By submitting this request form, you attest that all information provided is accurate.