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Agreement Receipt/Pick-Up Form

IN CONSIDERATION OF the undersigned entering an agreement with Midtown Mall; Midtown, Saskatchewan (the “Shopping Centre”) and receiving gift cards from the Shopping Centre on behalf of the Shopping Centre and/or another sponsor(s), the undersigned hereby agrees to release and waive any and all rights, claims, actions and demands which it may have against the Shopping Centre, Cushman & Wakefield Asset Services, their agents, employees, servants and representatives (referred to individually and collectively as the “Agreement Sponsor”) in respect of death or of injury to any person, or any loss or damage to any property, howsoever caused, arising out of or in connection with any defect or deficiency in and the possession and use of the gift card awarded by the Shopping Centre, and not withstanding that the same may have been contributed to or occasioned by the negligence of the Agreement Sponsor. The undersigned further grants a full and final release and discharge to the Agreement Sponsor from all obligations to me under or related in any way to the contest.

The undersigned further agrees to save harmless and keep indemnified the Agreement Sponsor from and against all claims, actions and demands by any party in respect of the death of or injury to any person or any loss or damages howsoever caused, arising out of or in connection with the possession and/or use of the gift cards awarded by the Shopping Centre and notwithstanding that the same may have been contributed to or occasioned by the negligence of the Agreement Sponsor. The undersigned further grants a full and final release to the Agreement Sponsor to the announcement of his or her name and the use of the city of his or her residence, photograph, likenesses, biographical information, voice and statements by Cushman & Wakefield Asset Services, and Midtown Mall for advertising and promotional purposes.

The undersigned hereby acknowledges the following item(s) (items have no CASH value and must be accepted as given):