Photograph and Testimonial Release and Permission

For other good and valuable consideration herein acknowledged as received, I hereby grant, on behalf of myself and my employer, to Qiagen Inc. (including its affiliated companies, agents, representatives and licensees) (“Company”) the absolute right and permission to use, publish, exhibit, distribute, record, display, edit, print and reproduce my photograph and testimonial about my experiences and impressions of Company’s products (“Testimonial”) together with any additional information that I choose to provide, including for example, my name, position and employer’s name (collectively the “Testimonial Information”).

I also consent in perpetuity to the Company’s use of the Testimonial Information, or any portion thereof, in any advertisement, marketing materials or other media (collectively, “Advertisements”) of the Company. I am not violating any policy of my employer by giving my Testimonial and have all necessary rights and authority needed from my employer to grant all the rights granted herein.

I acknowledge that Company will own all intellectual property rights in the Advertisements and that I will not receive any further compensation for granting the rights and releases given herein.

I hereby waive any right that I may have to inspect or approve the Advertisements or any derivative works thereof or any media displaying any portion of the Advertisements. I further waive and release Company from any claims or causes of action that I may have related to the Advertisements including by way of example only and without limitation, any right of publicity or privacy claims.

I hereby warrant that I am of full age and have the right to contract in my own name. I have read the above authorization, release, and agreement, prior to its execution, and I am fully familiar with the contents thereof. This release and permission shall be binding upon me and my heirs, legal representatives, and assigns.