Trade Show Interview & Media Release

Thank you for participating in an interview with Xenon Ophthalmics.

By signing this form, you grant Xenon Ophthalmics, Inc. permission to record and use your interview, name, voice, image, likeness, and statements in video, audio, photographs, and written materials.

These materials may be used for marketing, promotional, educational, and business purposes, including use on websites, social media, presentations, trade show materials, advertising, and other communications.

You acknowledge that:

• Your participation is voluntary.
• No compensation is provided unless separately agreed in writing.
• Xenon Ophthalmics may edit or adapt the recorded material.
• You waive the right to review or approve final materials.
• This permission is granted worldwide and in perpetuity.

You confirm that you are 18 years of age or older and have the authority to grant this permission.