SLAC NATIONAL ACCELERATOR LABORATORY 2575 SAND HILL ROAD MENLO PARK California 94025 USA

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SLAC NATIONAL ACCELERATOR LABORATORY 2575 SAND HILL ROAD MENLO PARK California 94025 USA

STANFORD SYNCHROTRON RADIATION LIGHTSOURCE LINAC COHERENT LIGHT SOURCE

POWER OF ATTORNEY

INDIVIDUAL INTERNATIONAL USER FOREIGN PRINCIPAL PARTY IN INTEREST (FPPI) / U.S. AGENT

I, ______, the Foreign Principal Party in Interest (Name of Individual International User) who is subject to the jurisdiction of ______and having an office and (Name of Country) place of business at ______(Address of Individual International User) hereby authorize the SLAC National Accelerator Laboratory (U.S. Agent) at 2575 Sand Hill Road, Menlo Park, CA 94025 to act as a lawful U.S. agent on my behalf. From this date, the U.S. agent is authorized, whether in writing, electronically, or by other means to:

 Act as my U.S. agent for Export Control, Census Reporting and Customs purposes;  Make, endorse or sign any Shipper’s Export Declaration or other documents or to perform any act which may be required by law or regulation in connection with the exportation or transportation of any merchandise shipped or consigned by or to me and to receive or ship any merchandise on my behalf.

I hereby certify that all statements and information contained in the documentation provided to the U.S. Agent relating to exportation are true and correct. Furthermore, I understand that civil and criminal penalties may be imposed for making false or fraudulent statements or for the violation of any United States laws or regulations on exportation.

This power of attorney is to remain in full force and effect until revocation in writing is duly given by me and received by the U.S. Agent.

Signed,

______(Full Printed Name of Individual International User)

Signature: ______Title: ______Date: ______

SLAC NATIONAL ACCELERATOR LABORATORY • 2575 SAND HILL ROAD • MENLO PARK • CALIFORNIA • 94025 • USA SLAC is operated by Stanford University for the U.S. Department of Energy

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