MICROSOFT HEX 168 CONTEST PARTICIPANT RELEASE FORM Please Print. A separate release must be completed and submitted for each Participating Entity or Third Party featured in the entry submission. Name: ____________________________________________________________ Age: ____________________ Address: ______________________________________________________________________________________ City: _____________________________________________ State: _____________ Zip Code: ________________ Day Phone ( ) ________________________________ Eve Phone ( ) ______________________________ Name of Original Entrant: ________________________________________________________________________ Submittal Title: _________________________________________________________________________________ Researcher ID (provided to Original Entrant at time of entry): __________________________________________ Check one: □ I am a Participating Entity, “under the power of hex” in the above referenced entry. □ I am a third party whose name and/or likeness appears in the above referenced entry. I am not a “Participating Entity” and thereby not eligible to receive a prize in this Contest. As a condition of having my name and likeness appearing in the above referenced entry (“participating entities”) submission for the Microsoft Hex 168 Contest (the “Contest”), I agree as follows: 1. To grant to Microsoft Corporation (the “Sponsor”) and its designees the worldwide and perpetual right and authority to use, publish, display and reproduce the entry in which I appear (in whole or in part), in any and all media, now or hereafter known, for promotional and marketing purposes including, without limitation, the right to display the entry on any website, television or radio broadcast, in print, or in any other media and to advertise and promote the Contest and subsequent contests sponsored by Sponsor (without notification to, permission from or compensation to me). 2. I have the right to enter into this agreement, and to grant the rights described in this agreement. I further represent that the consent of no other person (unless I am a minor) is required to enable the Sponsor and its designees to use the Material in connection with this Contest. 3. I acknowledge that no obligation exists on the part of the Sponsor or its designees to make use of any of the rights set forth herein. 4. On behalf of myself, my relatives, heirs, assignees, executors, administrators, successors and assigns, I hereby release and hold harmless Microsoft Corporation, and its subsidiaries and affiliates, prize suppliers, and advertising and promotional agencies, and each of the respective officers, directors, shareholders, agents, and employees of the aforementioned entities (collectively, the "Released Parties") from and against all claims and damages arising out of or relating in any way to the Released Parties’ exploitation of the rights granted herein. MICROSOFT HEX 168 CONTEST PARTICIPANT RELEASE FORM 5. I understand that the Released Parties are not responsible for unauthorized duplication or use of the entry in which I appear by third parties. 6. I further acknowledge that this document constitutes the entire agreement and complete understanding of the parties, and that no oral or prior written agreements shall be deemed a part of or modification of this agreement. This agreement cannot be modified except by a written instrument signed by an authorized representative of the Sponsor. Signature_________________________________________________________ Date: ___________ If the above-named person is a not the age of majority (but over 18 years of age) in his/her state of residence: I hereby consent and agree to the above as the Parent/Legal Guardian. ________________________________ ___________ Signature Date ____________________________________________ Please Print Name Executed Release Form(s): Executed release form(s) must be completed in full and submitted as follows to: By U.S. Mail: Mail completed forms to: Hex 168 Contest Release-Dept. RF, c/o Marden-Kane Inc., 36 Maple Place, Manhasset, NY 11030. By Fax: Fax the completed release forms to (516) 365-5259, Attention: Hex 168 Contest Release-Dept. RF. By e-mail: Send the forms in electronic format via email to: hex168@mardenkane.com. The completed and executed release form, if necessary, must be received by noon November 7, 2005, regardless of method of submission. Failure to complete and submit this form will result in the disqualification of the entry.