Eligius Awards Program Application & Release

I hereby grant to ELIGIUS® and/or its subsidiaries, agents, representatives, dealers, successors, assigns and licensees (collectively, “ELIGIUS®”) the permission to use my name, likeness, photograph or testimonial, or that of my minor child, as more specifically described in Exhibit A attached hereto, for any legitimate business purpose in ELIGIUS® sole discretion, including without limitation such purposes as marketing, advertising or general publicity, whether in tangible form or as a component of ELIGIUS® website. The grant includes the assignment of any rights, including copyrights and rights of publicity, I may have in the same and includes the right to make alterations without restriction as long as such alteration does not materially change the photograph, likeness, and/or testimonial I have provided.

I warrant and represent that the provisions of this Release are not in conflict with and do not violate any commitment, agreement, obligation or understanding that I now have or will in the future have with any other person or entity.

I hereby release and discharge ELIGIUS® for any claims, losses, damages or liabilities incurred by me to the extent arising from ELIGIUS® use of the photograph, likeness, and/or testimonial within the scope of my consent set forth herein.

This Release shall be governed by and construed in accordance with Indiana law, without respect to its conflict of laws principles, and any disputes hereunder shall be brought in the state or federal courts in Marion County, Indiana. This Release shall be binding upon me, my heirs, legal representatives, assigns, transferees, and successors in interest.

I certify that I: (i) am at least 18 years of age, (ii) have the legal right to sign for myself (or my minor child, as the case may be), (iii) have read this Release completely before signing it, and (iv) understand its contents.