In consideration for being allowed to attend or participate in any way or any manner in the DEALER PINK HALITE FIELD TRIPS sponsored by the Searles Lake Gem & Mineral Society and hosted by Searles Valley Minerals Inc., I ____________________________ (please print your name legibly), acknowledge, appreciate and agree that as a condition of attending or participating the DEALER PINK HALITE FIELD TRIPS, I will be bound by the following four (4) conditions and covenants:

1)      I acknowledge that there is a risk of injury from the activities involved in DEALER PINK HALITE FIELD TRIPS and while particular procedures and rules, equipment and personal caution and discipline may reduce this risk, some risk of injury will still exist; I understand that there will be risks ____________(initial).

2)      2) I KNOWINGLY & FREELY ASSUME ALL LIABILITY FOR ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF MYSELF OR OTHERS, & assume full responsibility and liability for my participation in any DEALER PINK HALITE FIELD TRIP.  I assume all liabilities __________(initial).

3)   I willingly agree to comply with the stated and customary terms and conditions for participation as stated in the FIELD TRIP RULES.  If I observe any significant hazard during my presence or participation, I will immediately remove myself from the hazard and immediately bring such hazard to the attention of a representative of the sponsor or host.  I agree to follow all rules and directions __________ (initial).

4)      4) I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS the Searles Lake Gem & Mineral Society and/or their officers, directors, affiliates, agents, or other participants (“releases”) AND Searles Valley Minerals Inc. and/or their officers, directors, affiliates, agents, or other participants (“releases”) WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, OR LOSS OR DAMAGE TO PERSON OR PROPERTY, WHETHER SUCH INJURY OCCURRED FROM THE NEGLIGENCE OF THE SPONSORING OR HOSTING PARTIES, CAUSED BY OTHER PARTICIPANTS, OR OTHERWISE.  I will hold harmless the Searles Lake Gem & Mineral Society and Searles Valley Minerals Corp in the event of any loss or injury ____________ (initial)

I have read this release of liability and assumption of risk agreement.  I fully understand its terms, understand that I have given up substantial rights by signing it, & sign it freely and voluntarily without any inducement.

Fill in the following information completely

______________________________            _________________________                    ________________

Name (print legibly)                                          Hand Written Signature                                                   Date

 __________________            _____________________     __________     __________

Street Address                                     City                                                       State                       ZIP

 ___________________________________________

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