First Name Last Name High Schoolfealer Name Y Y Participanlfiome Address City State ZIP Email Address El Please

se email me communications including product information. offers. incentives and surveys from Ford Motor Company and the local dealers, Before taking the testdrive, what is your overall opinion of the following brands on a scale to 10. where "1" is poor and "lO" is exceltent? I, undersigned, in consideration of riding in one or more automobiles at the above-named program. do hereby release. discharge, indemnify and hold harmless Ford Motor Company. Team Detroit. Inc., and any of their subsidiaries, officers. agents and employees (collectively. the releasees), from all claims. demands. actions or liabilities ofwhatever kind and nature. including but not limited to bodily injury. death or property damage arising from. or in any way connected to. the undersignecis use, operation, inspection or testing of said automobile or automobiles, whether negligent or otherwise. This also includes aii costs, losses or expenses in connection therewith arising from, or by reason of, any property damage arising out of any accident or occurrence during or in connection with said use, whether negligent or otherwise. I acknowledge that I have read and fully understand all of the foregoing, and that no officer, agent or employee of Ford Motor Company or Team Detroit. inc.. is authorized to vary the terms or provisions of this instrument, or make any representation contrary to the provisions hereof. l assume complete responsibility for all risks and for iniuries, death and/or property damage that may occur as a result of those risks, even if suth injuries, death or property damage octurs in a manner that is not foreseeable at the time I sign this release. I make these representations with the full understanding that you. the releaseesI are relying on these representations. I certify that I have a valid driver's license and am authorized to drive in the state in which the Event is being conducted; I have valid automobile insurance throughout the testing period: I and all passengers in my vehicle will use available safety belts while the vehicle is being operated; I am not aware of any medical condition or other circumstance that may affect my ability to participate in the Event; and i have not consumed alcoholic beverages or illegal substances prior to participating in the Event. The terms and provisions of this instrument snail be binding upon the heirs, executors or administrators of the undersigned. I certify that I have read the foregoing and am responsible for my actions. I certify that I am 18 years of age or older. with a valid drivers license. Signature Date Note: The Event stati reserves the right to refuse any partlcina nts demonstrating unruly or inappropriate oehav ior that mav result in iniurv to themselves or others. The possession or use of any alcoholic beverages will result in the automatic oisoualit ic ation ofthe participant from the drive. Such determinations ot retusalfdisoualic ation shall be at the sole discretion of the drive and Event staff. whose decisions shall be final in all respects. Event Participant grants permission to utilize Participants image. likeness. actions and statements in any live or recorded audio or photographic displav. or other transmission. exhibition, publication or reproduction ma oe ot or at the Event (regardless ot whether before. during or after the event) in any medium or conte xt without further authorization or compensation.

Now that you have taken the test-drive, what is your overall opinion ofthe following brands, on a scale toll), where is poor and is excellent? How was your opinion of Ford Motor Company impacted by your experience at this Drive One 4 UR School event? Would you say: El It makes it much better El It makes it somewhat better D It does not change my opinion [I lt makes itsornewhat worse El It makes it much worse (umhanged) Based on your test-drive experience. how likely would you consider purchasing or leasing from Ford Motor Company? llllery likely [ Likely l`LlUndecided iIlUn|ii<ely lj Very unlikely I am interested in receiving more information on the following vehicles: FORD IIIZOB C-MAX Energi/Hybrid |I|Expedition Elliex il Fusion [manger CIE-Series |I|Expl0rer E English / El Spanish CI English / El Spanish l|Super DutyDEdge E English / III Spanish |I|Fucus EIZUB Fusion Daurus Ei English /El Spanish El F-150 El English /El Spanish III 2013 Fusion Energi/Hybrid [ITransit Connect DEscape II] English / El Spanish Electric |I|Fusion Hybrid El Escape Hybrid D Fiesta E] 2013 Focus ST El Mustang El 2013 Escape El English /El Spanish El English / El Spanish LINCOLN C] Lincoln MKS El Lincoln C] Lincoln MKZ Hybrid El Lincoln Navigator El Lincoln MKT E Lincoln MKZ El ZUB Lincoln MKZ C] Lincoln Town Car Will you likey recommend that others take a look ata Ford vehicle? El Yes D No How many people do you plan on telling about your test-drive experience? |11 0 E 1-5 El 6-10 C111-15 1316+ 8. What part uf your test-drive experience do you plan nn telling others? . Please tell us your gender. El The vehicle I got to drive/ride |jThe chance to win a gift El What I learned about Ford Motor Company El The vehicle(s) on display activities I got to try/play or its vehicles El The exhibit/displays I saw iIlThe interaction with dealership staff What vehicle brand do you drive most often? E BMW EILexus El Nissan [Noikswagen [Buick E Dodge C] Pontiac Elther El Cadillac El Ford El Jeep El Mazda El Saturn El D0 not own a vehitle Clhevroiet [IGME El Kia |I|Men:edes-Benz EiToy0ta _ Which ofthe following categories best describes the vehicle you drive most often? l3Car El SUV/Crossover E Pickup Truck/Van II] Minivan _ When do you plan to acquire your next vehicle? El Oto 30 davs [] 1-3 months El 4-6 months 137+ months El No definite plans We would like to provide vou with the appropriate incentive information. How do you plan to obtain vour next vehicle? El Purchase D Lease If vou were to purchase or lease a new vehicle today, what make would vou most likely buv? |3Male ElFemale