Thank you for your patience as I reviewed this.
The form is copyrighted, and that precludes the ability to reproduce (copy) the form, and is a violation of 17 USC 106 which exposes the individual to liability if they use the form without permission.
However, the Board does sell these forms to the public:
Even though it is a template, it is a good idea to have an attorney review the form to ensure that the provisions are applicable to one's situation and has the desired affect. Most attorneys will do this for a flat fee.
Another option is to hire an attorney to prepare a custom document so that it can be used as a template going forward.
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