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CONFIDENTIAL DISCLOSURE

LIMITED USE AGREEMENT

for the Pediatric Quality of Life InventoryTM PedsQLTM Multidimensional Fatigue Scale
(PedsQLTM Multidimensional Fatigue Scale™)

THIS AGREEMENT WILL EXPIRE 7 DAYS AFTER RECEIPT.
THE COPY OF THE PedsQLTM Multidimensional Fatigue Scale SUPPLIED WITH THIS AGREEMENT MAY ONLY BE USED FOR EXAMINATION PURPOSES.
To view the questionnaire, please complete the following form:
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YOUR ACQUISITION OF AN EXAMINATION COPY OF PEDSQLTM MULTIDIMENSIONAL FATIGUE SCALE SIGNIFIES YOUR FULL AGREEMENT TO THE FOLLOWING CONDITIONS:

This License Agreement is for your limited use of the Pediatric Quality of Life InventoryTM PedsQLTM Multidimensional Fatigue Scale (PedsQLTM Multidimensional Fatigue Scale™) , copyright ©1998, JW Varni, PhD, All Rights Reserved.

This Agreement provides you with a personal, non-transferable, royalty-free, non-exclusive right and license to use the PedsQLTM Multidimensional Fatigue Scale for limited purpose of examining the suitability of the PedsQLTM Multidimensional Fatigue Scale for subsequent research and/or clinical use. This Agreement does not include: (1) any license for use of the PedsQLTM Multidimensional Fatigue Scale in research or in clinical practice(2) any license to sell or sublicense use of the PedsQLTM Multidimensional Fatigue Scale . The PedsQLTM Multidimensional Fatigue Scale may be examined only by persons whom you employ or whom you engage as independent contractors. You assume all risk for use of the PedsQLTM Multidimensional Fatigue Scale. This License only entitles you to obtain and use, for examination purposes, a single copy of the PedsQLTM Multidimensional Fatigue Scale.

You are not authorized to modify, retype, translate, copy or otherwise duplicate the PedsQLTM Multidimensional Fatigue Scale except with the further and prior written permission of LICENSOR (Mapi Research Trust on behalf of Dr. James Varni).

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For any information, please contact:
contact@mapi-trust.org