This Limited Evaluation Registration Form, upon completion, constitutes a legally binding agreement for the limited use of the AIRS Evaluation Product (as defined below) provided by AIRS Medical Inc.(”AIRS”) to the customer identified below (“Customer”).

The purpose of this Limited Evaluation Agreement is to provide for Customer’s no cost access and use of the AIRS Evaluation Product for the length of time reasonably necessary under the circumstances for Customer to assess the appropriate use and functionality of the AIRS Evaluation Product and to determine whether and when to use, order, purchase, or recommend the AIRS Evaluation Product in the future.