Common use of Acceptance Form Clause in Contracts

Acceptance Form. I have read the Amended and Restated Change of Control Protection Agreement, dated as of January 1, 2012 (“Agreement”) and the accompanying Release [and the information attached as Appendix I] 3 and hereby accept the benefits provided under the Agreement, subject to the terms and conditions set forth in the Agreement and Release. Print Name:______________________ Employee Date:______________________ Signature:________________________ Employee STATE OF NEW YORK ) ) ss: COUNTY OF _________ ) On this ___ day of __________ _______, before me personally came ____________ to be known and known to me to be the person described and who executed the foregoing Release, and (s)he duly acknowledged to me that (s)he executed the same. ________________________ Notary Public

Acceptance Form. I have read the Amended and Restated Change of Control Protection Agreement, dated as of January 1December 31, 2012 2008 (“Agreement”) and the accompanying Release [and the information attached as Appendix I] 3 and hereby accept the benefits provided under the Agreement, subject to the terms and conditions set forth in the Agreement and Release. Print Name:______________________ : Xxx Xxxxxxxx Date: Employee Date:______________________ Signature:________________________ : Employee STATE OF NEW YORK ) ) ss: COUNTY OF _________ ) On this ___ day of __________ _______, before me personally came ____________ to be known and known to me to be the person described and who executed the foregoing Release, and (s)he duly acknowledged to me that (s)he executed the same. ________________________ Notary Public

Acceptance Form. I have read the Amended and Restated Change of Control Protection Agreement, dated as of January 1, 2012 2006 (“"Agreement”") and the accompanying Release [and the information attached as Appendix I] 3 and hereby accept the benefits provided under the Agreement, subject to the terms and conditions set forth in the Agreement and Release. Print Name:______________________ Employee Date:______________________ Employee Signature:________________________ Employee STATE OF NEW YORK ) ) ss: COUNTY OF _________ ) On this ___ day of __________ _______, before me personally came ____________ to be known and known to me to be the person described and who executed the foregoing Release, and (s)he duly acknowledged to me that (s)he executed the same. ________________________ Notary Public.

Acceptance Form. I have read the Second Amended and Restated Change of Control Protection Agreement, dated as of January 1October 12, 2012 2011 (“Agreement”) and the accompanying Release [and the information attached as Appendix I] 3 and hereby accept the benefits provided under the Agreement, subject to the terms and conditions set forth in the Agreement and Release. Print Name: Xxxxxx Xxxxxxx Date:______________________ Employee Date:______________________ Signature:________________________ : Xxxxxx Xxxxxxx Employee STATE OF NEW YORK ) ) ss: COUNTY OF _________ ) On this ___ day of __________ _______, before me personally came ____________ Xxxxxx Xxxxxxx to be known and known to me to be the person described and who executed the foregoing Release, and (s)he duly acknowledged to me that (s)he executed the same. ________________________ Notary Public

Acceptance Form. I have read the Amended and Restated Change of Control Protection Agreement, dated as of January 1, 2012 ___________ (“Agreement”) and the accompanying Release [and the information attached as Appendix I] 3 and hereby accept the benefits provided under the Agreement, subject to the terms and conditions set forth in the Agreement and Release. Print Name:______________________ Employee Date:______________________ Employee Signature:________________________ Employee STATE OF NEW YORK ) ) ss: COUNTY OF _________ ) On this ___ day of __________ _______, before me personally came ____________ to be known and known to me to be the person described and who executed the foregoing Release, and (s)he duly acknowledged to me that (s)he executed the same. ________________________ Notary Public

Acceptance Form. I have read the Amended and Restated Change of Control Protection Agreement, dated as of January 1, 2012 (“Agreement”) and the accompanying Release [and the information attached as Appendix I] 3 and hereby accept the benefits provided under the Agreement, subject to the terms and conditions set forth in the Agreement and Release. Print Name:______________________ Employee Date:______________________ Employee Signature:________________________ Employee STATE OF NEW YORK ) ) ss: COUNTY OF _________ ) On this ___ day of __________ _______, before me personally came ____________ to be known and known to me to be the person described and who executed the foregoing Release, and (s)he duly acknowledged to me that (s)he executed the same. ________________________ Notary Public