In exchange for the sale of chaga mushroom to Birch Boys Chaga LLC, of 123 Park Street, Tupper Lake, New York, 12986, I, _________________, of _________________, _________________, _________________ _________________, agree to the following for myself:


1. AGREEMENT TO ACT LEGALLY. I agree to observe and obey any and all local, state, and/or federal laws. I agree not to harvest chaga from privately owned land without clear landowner permission. I agree not to harvest chaga from publicly and/or state owned land. I agree to leave approximately 15% of the chaga I harvest behind to allow for sustainable re-growth. I agree to submit all earnings to the Internal Revenue Service. I agree to complete and submit a W-9 Form (Request for Taxpayer Identification Number and Certification). I agree only to harvest chaga within the Adirondack State Park.


2. ASSUMPTION OF THE RISKS AND RELEASE. I recognize that there are certain inherent risks associated with the above described activity and I assume full responsibility for personal injury to myself, and further release and discharge Birch Boys Chaga LLC for injury, loss or damage arising out of my chaga harvesting activities.


3. APPLICABLE LAW. Any legal or equitable claim that may arise from participation in the above shall be resolved under New York law.


4. NO DURESS. I agree and acknowledge that I am under no pressure or duress to sign this Agreement and that I have been given a reasonable opportunity to review it before signing. I further agree and acknowledge that I am free to have my own legal counsel review this Agreement if I so desire.


5. ARM'S LENGTH AGREEMENT. This Agreement and each of its terms are the product of an arm's length negotiation between the Parties. In the event any ambiguity is found to exist in the interpretation of this Agreement, or any of its provisions, the Parties, and each of them, explicitly reject the application of any legal or equitable rule of interpretation which would lead to a construction either "for" or "against" a particular party based upon their status as the drafter of a specific term, language, or provision giving rise to such ambiguity.


6. ENFORCEABILITY. The invalidity or unenforceability of any provision of this Agreement, whether standing alone or as applied to a particular occurrence or circumstance, shall not affect the validity or enforceability of any other provision of this Agreement or of any other applications of such provision, as the case may be, and such invalid or unenforceable provision shall be deemed not to be a part of this Agreement.


7. DISPUTE RESOLUTION. The parties will attempt to resolve any dispute arising out of or relating to this Agreement through friendly negotiations amongst the parties. If the matter is not resolved by negotiation, the parties will resolve the dispute using the below Alternative Dispute Resolution (ADR) procedure.


Any controversies or disputes arising out of or relating to this Agreement will be submitted to mediation in accordance with any statutory rules of mediation. If mediation does not successfully resolve the dispute, then the parties may proceed to seek an alternative form of resolution in accordance with any other rights and remedies afforded to them by law.


Agreed to this _____ day of _____, in the year ____________.

By Signature: ___________________________ Print Name: ____________________________