Permission to Use Photographs and Videos

Subject: Photos/Videos Taken at KOFS and related events for marketing or social media purposes

Location: Kelowna Oral & Facial Surgery and affiliated events in the community

I grant to Kelowna Oral & Facial Surgery, its representatives, and employees the right to take
photographs of me and my property in connection with the above-identified subject. I authorize
Kelowna Oral & Facial Surgery, its assigns and transferees to copyright, use and publish the same in
print and/or electronically. I agree that Kelowna Oral & Facial Surgery may use such photographs of
me without my name and for any lawful purpose, including for example such purposes as
publicity, illustration, advertising, and Web content.

I have read and understand the above: