In consideration of the above, and for other good and valuable consideration, the receipt of which is hereby acknowledged:

1. I hereby irrevocably consent to and authorize the use and alteration by Myomo, Inc. (“Myomo”) on date(s) set forth above and/or for the above-identified project, as well as any other photographs or videos of me including testimony or quotes provided to Myomo or such authorized persons by any source with my consent (collectively, the “Appearances”), now or in the future in all media now known or hereafter developed, throughout the World for any purpose, including, but not limited to, in all forms of marketing and advertising. As between Myomo and me, the Appearances shall be the property of Myomo. I also consent to the use of my full name and likeness in connection with the Appearances.

2. I hereby waive any and all rights that I may be afforded by any applicable statute, law or regulation, under any jurisdiction anywhere in the World, in any way relating to the Appearances, including but not limited to, any right to inspect or approve any use of the Appearances or the materials in or on which they may appear, any right of privacy or publicity, and any copyright or moral right. I hereby release and discharge Myomo and its authorized representatives from any and all claims, actions and liabilities, whether known or unknown, including, but not limited to, claims of publicity or privacy rights violations, libel and compensation, that I or my heirs may have by reason of the exercise of the rights granted herein. I agree that any disputes arising in connection with this consent and release will be governed by the laws of the Commonwealth of Massachusetts, without regard to its choice of law provisions.

3. My heirs, executors, administrators and assigns shall be bound by this consent and release. I agree to execute such further assignments and instruments as may be reasonably necessary to enable Myomo to exercise, perfect and protect the benefits and rights granted in this consent and release. I am providing this consent and release voluntarily and of my own free will. I have read completely its terms and fully understand and accept them. I understand that no handwritten changes to this consent and release will be effective.