Eligibility Affidavit of Award and Release


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									This is an agreement where, in exchange for receiving the prize won in a contest, the
winner of a contest agrees to release the sponsor of the contest from all claims. The
winner also agrees that he is complying with the contest rules, will pay all taxes and
grants the sponsor the right to use his or her name, likeness and biographical data. It is
used to protect the sponsor from any potential claims that may arise from the contest
and serves as proof that the winner has received the prize. This form contains
numerous standard provisions and should be used whenever a company holds a
contest or sweepstakes.
                   Eligibility Affidavit of Award and Release
        This eligibility affidavit of award and release (“Agreement”) must be read and signed by
each person who is awarded a prize (“Prize”) in any contest or sweepstakes (“Promotion”)
sponsored by ___________ [Instruction: Insert Name of Sponsor], or any of its parent
companies, affiliates or subsidiaries (collectively, the “Sponsor”). A description of the Prize and
its value are set forth in Exhibit “A”, attached hereto and incorporated herein. The person who is
awarded the Prize shall hereinafter be referred to as the “Winner”. If the Winner is a legal
minor, the Winner's parent or legal guardian must also read and sign this Agreement. In
consideration of the awarding of the Prize to the Winner, and other good and valuable
consideration, the receipt and sufficiency of which is hereby acknowledged, the Winner (and if
the Winner is a minor, the Winner’s parent or legal guardian) agrees as follows:

1. The Winner represents and warrants that the Winner is eligible to receive the Prize in the
Promotion. Without limiting the foregoing, the Winner represents and warrants that the Winner
satisfies all eligibility requirements set forth in the official Promotion rules attached hereto as
Exhibit “B”, which the Winner acknowledges having read and understood.

2. The Prize shall be the Winner’s sole compensation, and without any additional
compensation, the Winner hereby irrevocably and perpetually grants to Sponsor the right to use,
adapt, reproduce, distribute, display and publicly perform the Winner’s name, likeness and
biographical data, in whole or in part, throughout the universe, in connection with the
promotional or marketing activities of Sponsor.

3. The Winner understands that any material that the Winner submits or has submitted to
Sponsor (the “Submitted Material”) is the sole property of Sponsor and may be used by Sponsor
for any purpose. The Winner further represents that the Winner independently created all
Submitted Material. The Winner hereby assigns and conveys to Sponsor all right, title and
interest in and to the Submitted Material (including all copyright and other intellectual property
rights therein), and will take any actions reasonably requested by Sponsor to effect, perfect and
evidence the foregoing assignment.

4. The Winner acknowledges that the Winner will be solely responsible for the payment of all
taxes (including, without limitation, income taxes), insurance, registration, and all other costs or
fees of any kind payable in connection with the receipt or use of the Prize.

5. If the Winner is a minor, the Winner's parent or legal guardian, by signing this Agreement,
agrees to hold the Prize in trust for the benefit of the Winner, and to be solely responsible for all
uses of the Prize and supervision of the Winner in connection with the Prize. The Winner shall
have the sole obligation of demonstrating the legal status of the Winner's parent or legal

6. The Winner acknowledges that the acceptance, participation in and/or use of any Prize are at
the Winner’s sole risk. The Winner, and the Winner’s assigns, heirs, devisees and estate
(collectively, the “Releasing Parties”), hereby unconditionally and forever release, discharge and
agree to hold harmless Sponsor and the Sponsor’s officers, directors, employees, agents and
contractors (collectively, the “Released Parties”), from any and all claims, judgments, costs,
damages, losses, expenses and liabilities relating to any claim the Releasing Party may now or
hereafter have with respect to any death, personal injury, property damage, pecuniary or other
loss, damage, cost or expense that may be suffered by as a result of the Promotion, any use by
Sponsor of the Winner’s name, likeness or biographical data, or in connection with the Winner’s
acceptance, participation in, use of and/or inability to use the Prize, even if such harm is caused
solely by the recklessness, negligence or fault of one or more of the Released Parties
(collectively, the “Released Claims”). If the Winner is a minor, the Winner’s parent or legal
guardian agrees to the foregoing indemnify. The Winner understands and agrees that this release
will prevent the Releasing Parties from bringing any Released Claims against any Released
Party, and from recovering any money damages or other relief from any Released Party in
connection with any of the Released Claims. To the extent permitted by law, the Winner hereby
waives the benefit of any provisions of any statute or other law that might adversely affect the
rights of any Released Party hereunder.

7. In the event that any provision or part of this Agreement shall be deemed void or invalid by a
court of competent jurisdiction, the remaining provisions or parts shall be and remain in full
force and effect.

8. This Agreement shall be governed in accordance with the laws of the State of
_____________, [Instruction: Insert State], applicable to agreements to be wholly performed
therein, with jurisdiction exclusive to the Federal and State courts located in the County of
_____________ [Instruction: Insert County], State of ______________ [Instruction: Insert

9. This Agreement constitutes the entire agreement between the parties hereto with respect to
the specific subject matter hereof and supersedes all prior agreements or understandings of any
kind with respect to the specific subject matter hereof. Any modification to this Agreement must
be in writing and signed by the parties or it shall have no effect and shall be void.

10. The Winner’s consent to the terms set forth herein is a material inducement for the Sponsor
to award a Prize to the Winner and the Sponsor would not do so in the absence of the Winner’s
consent as is evidenced by the Winner’s signature below.



Signature:   ________________________________ [Instruction: sign]
Name:        ___________ [Instruction: Insert Name of Winner]

Address:     ___________ [Instruction: Insert Address 1]
             ___________ [Instruction: Insert Address 2]

Email:       ___________ [Instruction: Insert Email Address]

Phone:       ___________ [Instruction: Insert Phone Number]

SSN:         ___________ [Instruction: Insert Social Security Number]

                  PARENT/LEGAL GUARDIAN (if Winner is a minor)

Signature:   ________________________________ [Instruction: sign]
Name:        ___________ [Instruction: Insert Name of Parent/Legal Guardian]

Address:     ___________ [Instruction: Insert Address 1]
             ___________ [Instruction: Insert Address 2]

Email:       ___________ [Instruction: Insert Email Address]

Phone:       ___________ [Instruction: Insert Phone Number]

SSN:         ___________ [Instruction: Insert Social Security Number]
                                       Exhibit “A”
                             (Description of Prize and Value)

Prize: ___________ [Instruction: Description of Prize and Value]
                                       Exhibit “B”
                               (Official Promotion Rules)

[Instruction: Attach Promotion Rules Here]

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