Model Release Form

Permission to Use Photographs, Video and Digital Recordings

Subject: Release Form

For good and valuable consideration, the receipt of which is hereby acknowledged, I grant ViaVan Technologies B.V. (“ViaVan”), and its representatives and employees, the
right to take photographs, video and digital recordings of me in connection with the above-identified subject.

I authorize ViaVan, its assigns and transferees to copyright, use and publish images of me in any and all of ViaVan’s print and/or electronic publications. I understand that any photograph, video or digital recording using my likeness will become property of ViaVan and will not be returned.

I acknowledge that my participation in this photo session with ViaVan is voluntary, and I will receive no compensation.

I hereby irrevocably authorize ViaVan to edit, alter, copy, exhibit, publish or distribute this photo for purposes of publicizing ViaVan’s commercial services or for any other related lawful purpose, including, but not limited to, publicity, illustration, advertising, and Web content. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears. Additionally, I expressly waive any right to royalties or other compensation arising or related to the use of the photographs, video or digital media bearing my likeness.

I hereby hold harmless and release and forever discharge ViaVan from any and all claims, demands and causes of action which I, my heirs, representatives, executors, administrators, or any other person acting on my behalf or on behalf of my estate have or may have by reasons of this authorization.