Legal Claims Release Form

LEGAL CLAIMS RELEASE FORM

This Legal Claims Release Form (the "Release") is entered into as of Effective Date: by and between Claimant Name: whose address is (hereinafter "Releasor"), and Released Party Name: whose address is (hereinafter "Releasee"). Releasor and Releasee are sometimes referred to individually as a "Party" and collectively as the "Parties."

Recitals

WHEREAS, Releasor asserts certain claims, demands, causes of action or liabilities, known or unknown, past or present, arising out of or relating to the facts, transactions, events or omissions described as:

WHEREAS, the Parties wish to resolve fully and finally any and all disputes between them without the expense, uncertainty or delay of further litigation; and

WHEREAS, Releasee denies liability, and this Release is not an admission of liability by Releasee but is made to avoid further dispute and expense.

NOW THEREFORE, in consideration of the mutual covenants and agreements herein and other good and valuable consideration the sufficiency of which is hereby acknowledged, the Parties agree as follows:

1. Release of Claims

Subject to the terms and conditions of this Release, Releasor, on behalf of Releasor and Releasor's heirs, executors, administrators, agents, representatives, successors and assigns, hereby fully and forever releases, waives and discharges Releasee and Releasee's past and present affiliates, subsidiaries, parents, officers, directors, employees, agents, insurers, attorneys and representatives (collectively, the "Released Parties") from any and all claims, demands, causes of action, obligations, damages, liabilities, and suits of any nature whatsoever, whether known or unknown, suspected or unsuspected, asserted or unasserted, that Releasor has or may have arising out of, in connection with or relating to the matters described in the Recitals through the Effective Date.

2. Consideration

In consideration for the promises and releases contained herein, Releasee shall pay or cause to be paid to Releasor the total amount of (United States dollars) in accordance with the following terms: Payment Date: . Payment of the consideration shall be the sole monetary obligation of Releasee under this Release.

3. Scope of Release and Excluded Claims

3.1 The release in Section 1 is intended to be a broad and general release. However, the following claims are expressly excluded from this Release and are not released:

Claims arising under workers' compensation statutes or similar mandatory benefits.

Criminal liability or claims that cannot be released as a matter of law.

Claims arising after the Effective Date of this Release.

4. Representations and Warranties

Releasor represents and warrants that Releasor has the full right, power and authority to enter into this Release and to execute and deliver the same, that Releasor has read and understands the terms of this Release, and that Releasor is not relying upon any statements or representations of Releasee or Releasee's representatives other than those expressly set forth in this Release.

5. No Admission of Liability

This Release is a compromise of disputed claims and shall not be construed as an admission of liability, fault, or wrongdoing by Releasee, any Released Party, or Releasor.

6. Confidentiality

Except as required by law, the Parties agree to keep the terms, amount and existence of this Release confidential. Disclosure to tax advisors, counsel or as required by law does not constitute a breach of this confidentiality provision.

7. Indemnification

Releasor shall indemnify and hold harmless Releasee and the Released Parties from and against any and all claims, demands, liabilities, damages, losses and expenses (including reasonable attorneys' fees) arising out of any breach of Releasor's representations, warranties or obligations under this Release.

8. Notices

Notices to Releasor

Notices to Releasee

All notices required or permitted by this Release shall be in writing and shall be deemed given when delivered personally, sent by nationally recognized overnight courier, or three (3) days after deposit in the United States mail, postage prepaid, to the addresses provided above unless another address is specified in writing.

9. Governing Law

This Release shall be governed by and construed in accordance with the laws of the State of without regard to conflict of law principles. Any dispute arising under this Release shall be resolved in the state or federal courts located in that State, and the Parties submit to the exclusive jurisdiction of such courts.

10. Entire Agreement

This Release contains the entire agreement between the Parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, understandings, negotiations and discussions, whether written or oral.

11. Severability

If any provision of this Release is held to be illegal, invalid or unenforceable under present or future laws effective during the term of this Release, such provision shall be fully severable and this Release shall be construed and enforced as if such illegal, invalid or unenforceable provision had never comprised a part of this Release.

12. Amendments and Waiver

No amendment, modification or waiver of any provision of this Release shall be effective unless in writing and signed by both Parties. Failure by either Party to enforce any provision shall not be construed as a waiver of that provision.

13. Counterparts; Electronic Signatures

This Release may be executed in counterparts, each of which shall be deemed an original and all of which together shall constitute one instrument. Signatures transmitted by facsimile or electronic means shall be deemed originals for all purposes.

IN WITNESS WHEREOF, the Parties hereto have executed this Release as of the Effective Date first written above.

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