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CONFIDENTIAL DISCLOSURE

LIMITED USE AGREEMENT

for the Pediatric Quality of Life InventoryTMPedsQLTM Family Impact Module
(PedsQLTM Family Impact Module ™)

THIS AGREEMENT WILL EXPIRE 7 DAYS AFTER RECEIPT.
THE COPY OF THE PedsQLTM Family Impact Module SUPPLIED WITH THIS AGREEMENT MAY ONLY BE USED FOR EXAMINATION PURPOSES.
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YOUR ACQUISITION OF AN EXAMINATION COPY OF PEDSQLTM FAMILY IMPACT MODULE SIGNIFIES YOUR FULL AGREEMENT TO THE FOLLOWING CONDITIONS:

This License Agreement is for your limited use of the Pediatric Quality of Life InventoryTMPedsQLTM Family Impact Module (PedsQLTM Family Impact Module ™) , 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 Family Impact Module for limited purpose of examining the suitability of the PedsQLTM Family Impact Module for subsequent research and/or clinical use. This Agreement does not include: (1) any license for use of the PedsQLTM Family Impact Module in research or in clinical practice(2) any license to sell or sublicense use of the PedsQLTM Family Impact Module . The PedsQLTM Family Impact Module 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 Family Impact Module . This License only entitles you to obtain and use, for examination purposes, a single copy of the PedsQLTM Family Impact Module .

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

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