THIS
WARRANT AND THE SECURITIES ISSUABLE UPON EXERCISE OF THIS WARRANT HAVE NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS
AMENDED (THE “ACT”), OR QUALIFIED UNDER ANY STATE SECURITIES LAWS AND MAY NOT BE OFFERED FOR SALE, SOLD, PLEDGED,
HYPOTHECATED OR OTHERWISE TRANSFERRED OR ASSIGNED UNLESS (I) A REGISTRATION STATEMENT COVERING SUCH SECURITIES IS EFFECTIVE UNDER
THE ACT AND IS QUALIFIED UNDER APPLICABLE STATE LAW OR (II) THE TRANSACTION IS EXEMPT FROM THE REGISTRATION AND PROSPECTUS DELIVERY
REQUIREMENTS UNDER THE ACT AND THE QUALIFICATION REQUIREMENTS UNDER APPLICABLE STATE LAW AND, IF THE COMPANY REQUESTS, AN OPINION
SATISFACTORY TO THE COMPANY TO SUCH EFFECT HAS BEEN RENDERED BY COUNSEL.


 


Original
Issue Date:                       


 


FOR
VALUE RECEIVED, Ballantyne Strong, Inc., a Delaware corporation (the “Company”), hereby certifies that
________________________  (the “Holder”), is entitled to purchase from the Company an aggregate of 100,000
duly authorized, validly issued, fully paid and nonassessable shares of Common Stock, all subject to the terms and conditions
set forth in this Warrant. Certain capitalized terms used herein are defined in Section 1.


 


1.
Definitions. As used in this Warrant, the following terms have the respective meanings set forth below:


 


“$10.00
Warrant Shares” has the meaning set forth in Section 2(a).


 


“$12.00
Warrant Shares” has the meaning set forth in Section 2(b).


 


“$14.00
Warrant Shares” has the meaning set forth in Section 2(c).


 


“$16.00
Warrant Shares” has the meaning set forth in Section 2(d).


 


“Aggregate
Exercise Price” means an amount equal to the product of (a) the number of Warrant Shares in respect of which this Warrant
is then being exercised pursuant to Section 3, multiplied by (b) the applicable Exercise Price.


 


“Board”
means the board of directors of the Company.


 


“Business
Day” means any day, except a Saturday, Sunday or legal holiday, on which banking institutions in the city of New York,
New York are authorized or obligated by law or executive order to close.


 


“Change
in Control” means that the Company shall, directly or indirectly, in one or more related transactions, consolidate or
merge with or into another Person, other than if (a) the Company is the surviving or resulting entity in the merger or consolidation,
(b) the merger or consolidation is effectuated with a direct or indirect subsidiary of the Company, or (c) the purpose of the
merger or consolidation is to reincorporate the domicile of the Company into another state.


 


“Common
Stock” means the Company’s common stock, par value $0.01 per share.


 


“Company”
has the meaning set forth in the preamble.


 




    	1



     


    

 


“Exercise
Date” means, for any given exercise of this Warrant, the date on which the conditions to such exercise as set forth
in Section 3 shall have been satisfied at or prior to 5:00 p.m., New York time, on a Business Day, including, without limitation,
the receipt by the Company of the Exercise Notice, this Warrant, and the Aggregate Exercise Price.


 


“Exercise
Notice” has the meaning set forth in Section 3(a)(1).


 


“Exercise
Period” has the meaning set forth in Section 2.


 


“Exercise
Price” means (i) with respect to the $10.00 Warrant Shares, $10.00 per share, (ii) with respect to the $12.00 Warrant
Shares, $12.00 per share, (iii) with respect to the $14.00 Warrant Shares, $14.00 per share, and (iv) with respect to the $16.00
Warrant Shares, $16.00 per share.


 


“Fair
Market Value” means the average of the daily volume weighted average prices per share of Common Stock for the ten (10)
consecutive trading days immediately preceding the day as of which Fair Market Value is being determined, as reported on the NYSE
American, or if the Common Stock is not listed on the NYSE American, as reported by the principal U.S. national or regional securities
exchange or quotation system on which the Common Stock is then listed or quoted; provided, however, if the Common Stock is not
listed or quoted on the NYSE American or any U.S. national or regional securities exchange or quotations system, then the “Fair
Market Value” of the Common Stock shall be the fair market value per share of Common Stock as determined by the Board.


 


“Holder”
has the meaning set forth in the preamble.


 


“Person”
means any individual, sole proprietorship, partnership, limited liability company, corporation, joint venture, trust, incorporated
organization or government or department or agency thereof.


 


“Securities
Act” has the meaning set forth in Section 9(a).


 


“Warrant”
means this Warrant and all warrants issued upon division or combination of, or in substitution for, this Warrant.


 


“Warrant
Shares” means the aggregate number of shares of Common Stock then purchasable upon exercise of this Warrant in accordance
with the terms of this Warrant, including the $10.00 Warrant Shares, the $12.00 Warrant Shares, the $14.00 Warrant Shares and
the $16.00 Warrant Shares.


 


2.
Purchase of Common Stock; Term of Warrant. Subject to the terms and conditions hereof, at any time or from time to time
after the date hereof and prior to 5:00 p.m., New York time, on the tenth anniversary of the date hereof or, if such day is not
a Business Day, on the next preceding Business Day (the “Exercise Period”), the Holder may exercise this Warrant
for all or any part of the Warrant Shares purchasable hereunder at the applicable Exercise Price set forth below:


 


(a)
25,000 shares
of Common Stock at a price per share of $10.00 (the “$10.00 Warrant Shares”);


 


(b)
25,000 shares
of Common Stock at a price per share of $12.00 (the “$12.00 Warrant Shares”);


 


(c)
25,000 shares
of Common Stock at a price per share of $14.00 (the “$14.00 Warrant Shares”); and


 


(d)
25,000 shares
of Common Stock at a price per share of $16.00 (the “$16.00 Warrant Shares”).


 




    	2



     


    

 


3.
Exercise of Warrant.


 


(a)
Exercise Procedure.
This Warrant may be exercised from time to time on any Business Day during the Exercise Period,
for all or any part of the unexercised Warrant Shares, at the applicable Exercise Price, upon: surrender of this Warrant to the
Company at its then principal executive offices (or an indemnification undertaking with respect to this Warrant in the case of
its loss, theft or destruction), together with a Notice of Warrant Exercise in the form attached hereto as Exhibit A
(each, an “Exercise Notice”),
duly completed (including specifying the number of $10.00 Warrant Shares, $12.00 Warrant Shares, $14.00 Warrant Shares, and/or
$16.00 Warrant Shares to be purchased) and executed; and


 


(2)
payment to the Company of the Aggregate Exercise
Price in accordance with Section 3(b).


 


For
the avoidance of doubt, the Holder, in its sole discretion, may exercise this Warrant pursuant to this Section 3 for all
or any part of the unexercised $10.00 Warrant Shares, $12.00 Warrant Shares, $14.00 Warrant Shares, or $16.00 Warrant Shares separately
or in any combination thereof.


 


(b)
Payment of the Aggregate Exercise Price. Payment of the Aggregate Exercise Price shall be made, at the option of the Holder
as expressed in the Exercise Notice, by the following methods:


 


(i)
by delivery to the Company of a certified or
official bank check payable to the order of the Company or by wire transfer of immediately available funds to an account designated
in writing by the Company in the amount of such Aggregate Exercise Price;


 


(ii)
by instructing the Company to withhold a number
of Warrant Shares then issuable upon exercise of this Warrant with an aggregate Fair Market Value as of the Exercise Date equal
to such Aggregate Exercise Price;


 


(iii)
by surrendering to the Company (A) Warrant Shares
previously acquired by the Holder with an aggregate Fair Market Value as of the Exercise Date equal to such Aggregate Exercise
Price and/or (B) other securities of the Company having a value as of the Exercise Date equal to the Aggregate Exercise Price
(which value in the case of debt securities shall be the principal amount thereof plus accrued and unpaid interest and in the
case of shares of Common Stock shall be the Fair Market Value thereof); or


 


(iv)
any combination of the foregoing.


 


(c)
Delivery
of Stock Certificates. Upon receipt by the Company of the Exercise Notice, surrender of this
Warrant and payment of the Aggregate Exercise Price in accordance with Sections 3(a) and (b), the Company shall, as promptly as
practicable, execute (or cause to be executed) and deliver (or cause to be delivered) to the Holder a certificate or certificates
representing the Warrant Shares issuable upon such exercise, together with cash in lieu of any fraction of a share, as provided
in Section 3(d). The stock certificate or certificates so delivered shall be, to the extent possible, in such denomination or
denominations as the Holder shall reasonably request in the Exercise Notice and shall be registered in the name of the Holder.
This Warrant shall be deemed to have been exercised and such certificate or certificates of Warrant Shares shall be deemed to
have been issued, and the Holder shall be deemed to have become a holder of record of such Warrant Shares for all purposes, as
of the Exercise Date.


 




    	3



     


    

 





(d)
Fractional
Shares The Company shall not be required to issue a fractional Warrant Share upon exercise
of any Warrant. As to any fraction of a Warrant Share that the Holder would otherwise be entitled to purchase upon such exercise,
the Company shall pay to the Holder an amount in cash (by delivery of a certified or official bank check or by wire transfer of
immediately available funds) equal to the product of (i) such fraction multiplied by (ii) the Fair Market Value of one Warrant
Share on the Exercise Date.


 


(e)
Delivery of New Warrant.
Unless the purchase rights represented by this Warrant shall have expired or shall have
been fully exercised, the Company shall, at the time of delivery of the certificate or certificates representing the Warrant Shares
being issued in accordance with Section 3(c), upon the request of the Holder, deliver to the Holder a new Warrant evidencing the
rights of the Holder to purchase the unexpired and unexercised Warrant Shares called for by this Warrant. Such new Warrant shall
in all other respects be identical to this Warrant. In the absence of a request from the Holder for a new Warrant pursuant to
this Section 3(e), the Company shall record and maintain records of the remaining rights of the Holder to purchase unexpired and
unexercised Warrant Shares pursuant to this Warrant. In the absence of manifest error, the records of the Company shall control
as to the remaining rights pursuant to this Warrant.


 


(f)
Valid
Issuance of Warrant and Warrant Shares. With respect to the exercise of this Warrant, the
Company hereby represents:


 


(i)
This Warrant is, and any Warrant issued in substitution
for or replacement of this Warrant shall be, upon issuance, duly authorized and validly issued.


 


(ii)
All Warrant Shares issuable upon the exercise
of this Warrant pursuant to the terms hereof shall be, upon issuance, validly issued, fully paid and non-assessable and issued
without violation of any preemptive or similar rights of any stockholder of the Company.


 


(g)
Reservation of Shares.
During the Exercise Period, the Company shall at all times reserve and keep available out
of its authorized but unissued Common Stock, solely for the purpose of issuance upon the exercise of this Warrant, the maximum
number of Warrant Shares issuable upon the exercise of this Warrant, and the par value per Warrant Share shall at all times be
less than or equal to the applicable Exercise Price. The Company shall take all such actions as may be necessary or appropriate
in order that the Company may validly and legally issue fully paid and nonassessable shares of Common Stock upon the exercise
of this Warrant.


 


4.
Adjustment upon Subdivision or Combination of Common Stock. If the Company at any time after the date of issuance of this
Warrant subdivides (by any stock split, stock dividend, recapitalization or otherwise) one or more classes of its outstanding
shares of Common Stock into a greater number of shares, the Exercise Price in effect immediately prior to such subdivision will
be proportionately reduced and the number of Warrant Shares will be proportionately increased. If the Company at any time after
the date of issuance of this Warrant combines (by combination, reverse stock split or otherwise) one or more classes of its outstanding
shares of Common Stock into a smaller number of shares, the Exercise Price in effect immediately prior to such combination will
be proportionately increased and the number of Warrant Shares will be proportionately decreased. Any adjustment under this Section
4 shall become effective at the close of business on the date the subdivision or combination becomes effective.


 




    	4



     


    

 


5.
Restriction on Transfer of Warrant. This Warrant and all rights hereunder may not be transferred or assigned, in whole
or in part, without the prior written consent of the Company and compliance with the transfer conditions referred to in the legend
endorsed hereon. Any attempted transfer or assignment which is not in accordance with this Section 5 shall be null and void and
the transferee or assignee shall not be entitled to exercise any of the rights of the Holder of this Warrant. The Company shall
record any transfers or assignments in the books maintained for the registration and transfer of this Warrant in accordance with
Section 10.


 


6.
No Stockholder Rights; Limitations on Liability. Prior to the issuance to the Holder of the Warrant Shares to which the
Holder is then entitled to receive upon the due exercise of this Warrant, the Holder shall not be entitled to vote or receive
dividends or be deemed the holder of shares of capital stock of the Company for any purpose, nor shall anything contained in this
Warrant be construed to confer upon the Holder, as such, any of the rights of a stockholder of the Company or any right to vote,
give or withhold consent to any corporate action (whether any reorganization, issue of stock, reclassification of stock, consolidation,
merger, conveyance or otherwise), receive notice of meetings, receive dividends or subscription rights, or otherwise. In addition,
nothing contained in this Warrant shall be construed as imposing any liabilities on the Holder to purchase any securities (upon
exercise of this Warrant or otherwise) or as a stockholder of the Company, whether such liabilities are asserted by the Company
or by creditors of the Company.


 


7.
Treatment of Warrant Upon a Change in Control. Upon the consummation of a Change in Control of the Company, then, to the
extent this Warrant has not already been exercised in full or otherwise terminated, expired or canceled, this Warrant shall automatically
terminate and be of no further force or effect. The Company shall provide the Holder with notice of any Change in Control at least
fourteen (14) days prior to the consummation thereof.


 


8.
Replacement on Loss; Division and Combination.


 


(a)
Replacement
on Loss. Upon receipt of evidence reasonably satisfactory to the Company of the loss, theft,
destruction or mutilation of this Warrant and upon delivery of an indemnity reasonably satisfactory to it (it being understood
that a written indemnification agreement or affidavit of loss of the Holder shall be a sufficient indemnity) and, in case of mutilation,
upon surrender of such Warrant for cancellation to the Company, the Company at its own expense shall execute and deliver to the
Holder, in lieu hereof, a new Warrant of like tenor and exercisable for an equivalent number of Warrant Shares as the Warrant
so lost, stolen, destroyed or mutilated; provided that, in the case of mutilation, no indemnity shall be required if this Warrant
in identifiable form is surrendered to the Company for cancellation.


 


(b)
Division
and Combination. Subject to compliance with the applicable
provisions of this Warrant, including without limitation Section 5 hereof, this Warrant may be divided or, following any such
division of this Warrant, combined with other Warrants upon the surrender of this Warrant or Warrants to the Company at its then
principal executive offices, together with a written notice specifying the denominations in which new Warrants are to be issued,
signed by the Holder. Subject to compliance with the applicable provisions of this Warrant, the Company shall at its own expense
execute and deliver a new Warrant or Warrants in exchange for the Warrant or Warrants so surrendered in accordance with such notice.
Such new Warrant or Warrants shall be of like tenor to the surrendered Warrant or Warrants and shall be exercisable in the aggregate
for an equivalent number of Warrant Shares as the Warrant or Warrants so surrendered in accordance with such notice.


 






    	5



     


    

 


9.
Compliance with the Securities Act.


 


(a)
Agreement to Comply with the Securities Act.
The Holder, by acceptance of this Warrant, agrees to comply in all respects with the provisions of this Section 9 and the
restrictive legend requirements set forth on the face of this Warrant and further agrees that such Holder shall not offer, sell
or otherwise dispose of this Warrant or any Warrant Shares to be issued upon exercise hereof except under circumstances that will
not result in a violation of the Securities Act of 1933, as amended (the “Securities Act”). This Warrant and
all Warrant Shares issued upon exercise of this Warrant (unless registered under the Securities Act) shall be stamped or imprinted
with a legend in substantially the following form:


 


“THIS
WARRANT AND THE SECURITIES ISSUABLE UPON EXERCISE OF THIS WARRANT HAVE NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS
AMENDED (THE “ACT”), OR QUALIFIED UNDER ANY STATE SECURITIES LAWS AND MAY NOT BE OFFERED FOR SALE, SOLD, PLEDGED,
HYPOTHECATED OR OTHERWISE TRANSFERRED OR ASSIGNED UNLESS (I) A REGISTRATION STATEMENT COVERING SUCH SECURITIES IS EFFECTIVE UNDER
THE ACT AND IS QUALIFIED UNDER APPLICABLE STATE LAW OR (II) THE TRANSACTION IS EXEMPT FROM THE REGISTRATION AND PROSPECTUS DELIVERY
REQUIREMENTS UNDER THE ACT AND THE QUALIFICATION REQUIREMENTS UNDER APPLICABLE STATE LAW AND, IF THE COMPANY REQUESTS, AN OPINION
SATISFACTORY TO THE COMPANY TO SUCH EFFECT HAS BEEN RENDERED BY COUNSEL.”


 


(b)
Representations of the Holder. The Holder
represents, as of the date hereof, to the Company by acceptance of this Warrant as follows:


 


(i)
The Holder is an “accredited investor”
as defined in Rule 501(a) of Regulation D promulgated under the Securities Act. The Holder is acquiring this Warrant and the Warrant
Shares to be issued upon exercise hereof for investment for its own account and not with a view towards, or for resale in connection
with, the public sale or distribution of this Warrant or the Warrant Shares, except pursuant to sales registered or exempted under
the Securities Act.


 


(ii)
The Holder understands and acknowledges that
this Warrant and the Warrant Shares to be issued upon exercise hereof are “restricted securities” under federal securities
laws inasmuch as they are being acquired from the Company in a transaction not involving a public offering and that, under such
laws and applicable regulations, such securities may be resold without registration under the Securities Act only in certain limited
circumstances. In addition, the Holder represents that it is familiar with Rule 144 under the Securities Act, as presently in
effect, and understands the resale limitations imposed thereby and by the Securities Act.


 


(iii)
The Holder acknowledges that it can bear the
economic and financial risk of its investment for an indefinite period, and has such knowledge and experience in financial or
business matters that it is capable of evaluating the merits and risks of the investment in this Warrant and the Warrant Shares.
The Holder has had an opportunity to ask questions and receive answers from the Company regarding the terms and conditions of
the offering of this Warrant and the business, properties, prospects and financial condition of the Company.


 


10.
Warrant Register. The Company shall keep and properly maintain at its principal executive offices books for the registration
of this Warrant and any transfers thereof. The Company may deem and treat the Person in whose name this Warrant is registered
on such register as the Holder hereof for all purposes, and the Company shall not be affected by any notice to the contrary, except
any division, combination or other transfer of the Warrant effected in accordance with the provisions of this Warrant.


 






    	6



     


    




 


11.
Notices. All notices, requests, consents, claims, demands, waivers and other communications
hereunder shall be in writing and shall be deemed to have been given: (a) when delivered by hand (with written confirmation of
receipt); (b) when received by the addressee if sent by a nationally recognized overnight courier (receipt requested); (c) on
the date sent by facsimile of a PDF document (with confirmation of transmission) if sent during normal business hours of the recipient,
and on the next Business Day if sent after normal business hours of the recipient; or (d) on the third day after the date mailed,
by certified or registered mail, return receipt requested, postage prepaid. Such communications must be sent to the respective
parties at the addresses indicated below (or at such other address for a party as shall be specified in a notice given in accordance
with this Section 11).


 


	If
    to the Company:	Ballantyne
                                         Strong, Inc.

        11422
        Miracle Hills Drive, Suite 300

        Omaha, Nebraska 68154

	 	Facsimile:
    [                    ]
	 	Attention:
    Chief Financial Officer
	 	 
	If
    to the Holder:	_________________________

        [                  ]

        

	 	[                  ]
	 	Facsimile:
    [                    ]
	 	E-mail:
    [                        ]
	 	Attention:
    [                         ]


 


12.
Entire Agreement. This Warrant constitutes the sole and entire agreement of the parties to
this Warrant with respect to the subject matter contained herein, and supersedes all prior and contemporaneous understandings
and agreements, both written and oral, with respect to such subject matter.


 


13.
Successor and Assigns. This Warrant and the rights evidenced
hereby shall be binding upon and shall inure to the benefit of the parties hereto and the successors of the Company and the successors
and permitted assigns of the Holder. Such successors and/or permitted assigns of the Holder shall be deemed to be a Holder for
all purposes hereunder.


 


14.
No Third-Party Beneficiaries. This Warrant is for the sole benefit of the Company and the Holder and their respective successors
and, in the case of the Holder, permitted assigns and nothing herein, express or implied, is intended to or shall confer upon
any other Person any legal or equitable right, benefit or remedy of any nature whatsoever, under or by reason of this Warrant.


 


15.
Headings. The headings in this Warrant are for reference
only and shall not affect the interpretation of this Warrant.


 






    	7



     


    




 


16.
Amendment; Waiver. Except as otherwise provided herein, this Warrant may only be amended or modified by an agreement in
writing signed by each party hereto. No waiver by the Company or the Holder of any of the provisions hereof shall be effective
unless explicitly set forth in writing and signed by the party so waiving. No waiver by any party shall operate or be construed
as a waiver in respect of any failure, breach or default not expressly identified by such written waiver, whether of a similar
or different character, and whether occurring before or after that waiver. No failure to exercise, or delay in exercising, any
rights, remedy, power or privilege arising from this Warrant shall operate or be construed as a waiver thereof; nor shall any
single or partial exercise of any right, remedy, power or privilege hereunder preclude any other or further exercise thereof or
the exercise of any other right, remedy, power or privilege.


 


17.
Severability. If any term or provision of this Warrant
is invalid, illegal or unenforceable in any jurisdiction, such invalidity, illegality or unenforceability shall not affect any
other term or provision of this Warrant or invalidate or render unenforceable such term or provision in any other jurisdiction.


 


18.
Governing Law. This Warrant shall be governed by and construed
in accordance with the internal laws of the State of Delaware without giving effect to any choice or conflict of law provision
or rule that would cause the application of laws of any jurisdiction other than those of the State of Delaware.


 


19.
Counterparts. This Warrant may be executed in counterparts,
each of which shall be deemed an original, but all of which together shall be deemed to be one and the same agreement. A signed
copy of this Warrant delivered by facsimile, email or other means of electronic transmission shall be deemed to have the same
legal effect as delivery of an original signed copy of this Warrant.


 


20.
No Strict Construction. This Warrant shall be construed
without regard to any presumption or rule requiring construction or interpretation against the party drafting an instrument or
causing any instrument to be drafted.


 


[SIGNATURE
PAGE FOLLOWS]


 




    	8



     


    

 


IN
WITNESS WHEREOF, the Company has duly executed this Warrant on the Original Issue Date set forth above.


 


	 	 	 	Ballantyne
                                         Strong, Inc.






	 	 	 	 	 
	 	 	 	By:	
	 	 	 	Name:	D.
    Kyle Cerminara
	 	                                          	 	Title:	Chief
    Executive Officer
	 	 	 	 	 
	Accepted
    and Agreed:	 	 	 
	 	 	 	 	 
	



 ________________________



	 	 	                          
	 	 	 	 	 
	By:	 	 	 	 
	Name:
    	 	 	 	 
	Title:
    	 	 	 	 





 




    	9



     


    




 





Exhibit
A


 


Form
of Notice of Warrant Exercise


 


	To:	Ballantyne
    Strong, Inc. 
	 	11422
    Miracle Hills Drive, Suite 300
	 	Omaha,
    Nebraska 68154
	 	Attn:
    Chief Financial Officer


 


Reference
is hereby made to that certain Warrant issued by Ballantyne Strong, Inc., a Delaware corporation (the “Company”),
to _______________________  (the “Holder”), on ____________,
2018. (the “Warrant”). All capitalized terms used but not otherwise defined herein shall have the meanings
ascribed to such terms in the Warrant.


 


1.
Exercise of Warrant. The Holder irrevocably elects to purchase _____ Warrant Shares pursuant to the terms of the Warrant,
including _____ $10.00 Warrant Shares, _____ $12.00 Warrant Shares, _____ $14.00 Warrant Shares and _____ $16.00 Warrant Shares.
This notice is accompanied by the original Warrant, which is hereby surrendered to the extent necessary to effect the exercise.


 


2.
Payment of Aggregate Exercise Price. The Holder tenders herewith to the Company payment of the Aggregate Exercise Price
in full by means of:


 


	 	_________	Certified
    or official bank check payable to the order of the Company.
	 	 	 
	 	_________	Wire
    transfer of immediately available funds to an account designated in writing by the Company.
	 	 	 
	 	_________	Surrender
    of Warrant Shares previously acquired by the Holder with an aggregate Fair Market Value as of the Exercise Date equal to the
    Aggregate Exercise Price and/or other securities of the Company having a value as of the Exercise Date equal to the Aggregate
    Exercise Price.
	 	 	 
	 	_________	Surrender
    of the right to receive Warrant Shares having an aggregate Fair Market Value as of the date hereof equal to the Aggregate
    Exercise Price.
	 	 	 
	 	_________	A
    combination of the foregoing as follows:


 


3.
Warrant Shares. The Holder represents that all representations of the Holder set forth in Section 9(b) of the Warrant
are true and correct as of the date hereof.


 


	 	                                                                                  	 	____________________________
	 	 	 	 	 
	 	 	 	By:	                                              
	 	 	 	Name:	 
	 	 	 	Title:	 
	 	 	 	 	          
	Dated:	 	 	 	 







 






    	10