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Publicity Waiver and Release Form

Össur Australia Pty Ltd located at 26 Ross Street, North Parramatta, NSW 2151 ("Össur") desires to use and publicise the name, image, likeness and other personal characteristics and private information of the individual named below ("I" or "me") for advertising, promotion and other business purposes. In exchange for good and valuable consideration, I give Össur my permission for such use and publicity for such purposes, according to the terms and conditions set forth in this Publicity Waiver and Release ("Agreement").

I hereby irrevocably permit, authorise and license Össur and its affiliates, successors and assigns, and the employees, officers, directors and agents of each ("Authorised Persons"), to display, reproduce, edit, create derivative works, sell, rent, license, otherwise use and permit others to use my name, image, likeness, voice, and all materials created by or on behalf of Össur that incorporate any of the foregoing ("Materials") on a perpetual basis throughout the world and in any medium or format whatsoever now existing or hereafter created for any purpose without further consent from or royalty, payment or other compensation to me. I hereby irrevocably transfer and assign to Össur my entire right, title and interest, if any, in and to the Materials and all copyrights in the Materials arising in any jurisdiction throughout the world, including the right to register and sue to enforce such copyrights against infringers. I acknowledge and agree that Össur shall have the right to use or distribute Materials without my prior review or approval, and that Össur has no liability to me for any editing or alteration of the Materials or for any distortion or other effects therefrom. Össur has no obligation to use the Materials or to exercise any rights given by this Agreement.

To the fullest extent permitted by applicable law, I hereby irrevocably waive all legal and equitable rights relating to all liabilities, claims, demands, actions, suits, damages and expenses, including but not limited to claims for copyright or trademark infringement, infringement of moral rights, defamation, invasion of rights of privacy, rights of publicity, intrusion, false light, public disclosure of private facts, physical or emotional injury or distress or any similar claim or cause of action in tort, contract or any other legal theory, now known or hereafter known in any jurisdiction throughout the world (collectively, "Claims") arising directly or indirectly from the use of the Materials and agree not to make or bring any such Claim against any Authorised Person.

This Agreement constitutes the sole and entire agreement of the parties with respect to the subject matter contained herein and supersedes all prior and contemporaneous understandings, agreements, representations and warranties, both written and oral, with respect to such subject matter. If any term or provision of this Agreement is invalid, illegal or unenforceable in any jurisdiction, such invalidity, illegality or unenforceability shall not affect any other term or provision of this Agreement or invalidate or render unenforceable such term or provision in any other jurisdiction. This Agreement is binding on and shall inure to the benefit of the parties hereto and their respective successors and assigns.

YOU ACKNOWLEDGE THAT YOU HAVE READ AND UNDERSTOOD ALL OF THE TERMS OF THIS AGREEMENT AND PROVIDE YOUR ABSOLUTE AND UNCONDITIONAL CONSENT, WAIVER AND RELEASE OF LIABILITY.