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By submitting this form you are agreeing to let Buehler use the attached image if chosen as a calendar image upon where you will be awarded with a $200 honorarium. If your image is not chosen for the calendar year this submission was for, we reserve the right to consider the image in following years calendars and will be awarded a $200 honorarium if we do so.

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Illinois Tool Works Inc. (ITW)

CONSENT AND RELEASE FORM

I, [name and title of individual(s) on calendar submission form], residing at [address on calendar submission form], hereby agree as follows:

a) ITW shall own all rights in and to the photographic portraits, pictures, videos and images given to ITW by me, and any reproductions thereof (hereinafter “Photograph”).

b) I hereby grant to ITW an irrevocable and non-exclusive perpetual license (i) in the Photograph, including the rights to copyright, distribute, copy, create derivative works from, and/or publicly display the Photograph in any manner and in any medium or media, now known or later discovered, including over the Internet, and (ii) to use my name in connection with the Photograph. I understand that the Photograph and my name may be used by ITW to advertise or promote ITW or any of its products or services, and I hereby consent to such use.

c) I understand and agree that I will have no right to inspection or approval over any use of the Photograph by ITW. I understand and agree that ITW may modify the Photograph as it sees fit and that ITW is under no obligation to use the Photograph in any manner.

d) I hereby expressly waive any and all rights of privacy, publicity, and moral rights concerning ITW’s use of the Photograph.