Third Party Release Form

THIRD PARTY RELEASE AGREEMENT

This Third Party Release Agreement ("Agreement") is entered into as of by and between Releasor Name: whose address is (hereinafter "Releasor"), and Releasee Name: whose address is (hereinafter "Releasee"). The parties agree as follows:

RECITALS

WHEREAS, on or about an incident or dispute occurred involving the parties and/or third parties, described as:

WHEREAS, the parties desire to fully and finally resolve and compromise any and all claims, demands, causes of action, liabilities, and disputes that the Releasor has or may have against Releasee arising out of or related to the incident described above; and

WHEREAS, Releasor acknowledges that the consideration described below is fair and adequate to fully compensate Releasor and to effect the release provided herein.

NOW, THEREFORE, in consideration of the mutual covenants and promises contained herein and other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the parties agree as follows:

1. DEFINITIONS

For purposes of this Agreement, "Claims" means any and all actions, causes of action, suits, debts, dues, sums of money, accounts, damages, judgments, obligations, liabilities, costs, expenses, losses, demands and rights of any kind or nature, whether known or unknown, fixed or contingent, suspected or unsuspected, asserted or unasserted, arising out of or related to the incident described above.

2. RELEASE

Subject to the terms set forth herein, Releasor hereby fully, finally and forever releases, relinquishes, and discharges Releasee, and each of Releasee's past and present agents, employees, insurers, representatives, successors and assigns, from any and all Claims that Releasor now has, or at any time heretofore had, or which Releasor or Releasor's heirs, executors, administrators or assigns hereafter may have, whether known or unknown, suspected or unsuspected, arising out of or related to the incident described in this Agreement.

3. CONSIDERATION

The parties acknowledge that the consideration described above (and any non-monetary consideration described herein) is the full and complete consideration for the releases, covenants and promises contained in this Agreement.

4. NO ADMISSION OF LIABILITY

The parties expressly agree that this Agreement is a compromise of disputed claims and that neither the furnishing of consideration nor anything contained in this Agreement shall be construed as or deemed to be an admission of liability, fault or wrongdoing by any party.

5. REPRESENTATIONS AND WARRANTIES

Releasor represents and warrants that Releasor is the sole owner of the Claims released herein, that Releasor has the full right, power and authority to execute this Agreement and to release the Claims, and that there are no liens, encumbrances or assignments of any kind affecting the Claims except as expressly disclosed in writing in the space below.

6. INDEMNIFICATION

Releasor shall indemnify, defend and hold harmless Releasee from and against any and all third-party claims, demands, damages, liabilities, costs and expenses (including reasonable attorneys' fees) arising out of any breach by Releasor of the representations, warranties or covenants contained in this Agreement.

7. CONFIDENTIALITY

Except as required by law or as necessary to enforce the terms of this Agreement, the parties agree to keep the terms, amounts and circumstances of this Agreement confidential and not to disclose them to any third party. Notwithstanding the foregoing, either party may disclose the terms to legal counsel, tax advisors or as required by court order.

8. WAIVER OF UNKNOWN CLAIMS

Releasor expressly understands and acknowledges that this release includes a release of claims that are not now known or suspected to exist and expressly waives any statute or doctrine that would limit the scope of this release with respect to unknown claims. Releasor affirms that Releasor has had the opportunity to seek legal counsel prior to executing this Agreement.

9. NOTICES

All notices required or permitted under this Agreement shall be in writing and shall be deemed given when delivered personally, sent by nationally recognized overnight courier, or three (3) business days after deposit in the United States postal service, postage prepaid, addressed as follows:

10. AMENDMENT; WAIVER; COUNTERPARTS

This Agreement may be amended or modified only by a written instrument executed by both parties. No waiver of any breach shall be deemed a waiver of any subsequent breach. This Agreement may be executed in counterparts, each of which shall be deemed an original, and all of which together shall constitute one and the same instrument.

11. GOVERNING LAW

This Agreement shall be governed by and construed in accordance with the laws of the jurisdiction where Releasee is principally located, without regard to conflict of law principles that would result in the application of another jurisdiction's laws.

12. ENTIRE AGREEMENT; SEVERABILITY

This Agreement constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, understandings and negotiations, whether written or oral. If any provision of this Agreement is determined to be invalid, illegal or unenforceable in any respect, the validity, legality and enforceability of the remaining provisions shall not in any way be affected or impaired thereby.

REPRESENTATION OF VOLUNTARY EXECUTION

Releasor acknowledges that Releasor has read this Agreement, understands its terms, and executes it voluntarily and with full knowledge of its significance. Releasor further acknowledges the opportunity to consult with independent legal counsel of Releasor's choice before signing.

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