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INSTRUCTIONS FOR THE COMPLETION OF THE AFFIDAVIT OF ELIGIBILITY

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INSTRUCTIONS FOR THE COMPLETION OF THE AFFIDAVIT OF ELIGIBILITY Powered By Docstoc
					                   INSTRUCTIONS FOR THE COMPLETION OF THE
               AFFIDAVIT OF ELIGIBILITY AND PHOTO/VIDEO RELEASE


       Attached hereto is an Affidavit of Eligibility and Photo/Video Release (the “Pre-Publication
Affidavit”). In accordance with the Competition Rules, you must complete the Pre-Publication
Affidavit by:

              Filling in the email address under which you entered the Contest and all other
               information requested;

              Attaching a copy of two forms of identification. At least one of the two forms of
               identification must be a valid government-issued ID that includes your photograph
               and date of birth – such as a driver's license, passport or state/provincial
               identification card. The other form of identification need not be issued by the
               government, but must verify your identity (such as school or employer identification
               card, social security card, or birth certificate); and

              Presenting the original of both forms of identification to a Notary Public, and
               signing the Pre-Publication Affidavit in front of a Notary Public.

While there is no requirement that you return the Publication Affidavit unless you are selected as a
Semi-Finalist, it is preferable for you to do so. Remember that the deadlines for Semi-Finalists may
be tight, so it is best to get started on it now. The actual deadline will be included on the notice that
you may receive indicating that you had been chosen as a Semi-Finalist.

       In the U.S., Notary Publics can usually be found at your local bank, real estate offices and
insurance agencies. They may charge a small fee – usually $5 or less for their service. We cannot
accept Pre-Publication Affidavits that have not been notarized and we are not responsible for
the payment of any fees or costs, including the notary fees.

        Please pay special attention to paragraphs 19 through 21 of the Pre-Publication
Affidavit, which must be initialed by you, relating to rights in the Submitted Photographs and
Additional Submitted Materials and all other materials of any type whatsoever including
without limitation video, audio, film, paper documents, biographical information that you
may choose or we may require you to submit to us (herein collectively, “Submitted Assets”).
We will not return any Submitted Assets to you at any time. If you do not personally hold the
copyright to the photographic images and/or videos you are submitting – for example, the photos
are professional model shots or were taken by a professional photographer – you must demonstrate
that the copyright holder has granted you the right to allow Alpha Media Group Inc., its parent
corporation, subsidiaries and affiliates (collectively, “AMG”) to reproduce and to publish the
Submitted Assets to the extent of the permission granted herein. If the photographer, videographer,
or any other party owns the copyrights to the Submitted Assets (the “Copyright Holder”), you must
provide us with the Copyright Release, a copy of which was linked to the License Agreement when
you entered the Competition, and which is available HERE www.hometownhotties.com/2011-
Copyright-Release signed by the Copyright Holder(s), or you will be ineligible to participate in the
Competition. You are solely responsible for any financial reimbursement to the original
Copyright Holder for the rights to publish the Submitted Assets; the Competition Entities will
not be responsible for any such payment.


       Return the signed original of the Pre-Publication Affidavit by mail to:

                               2011 Hometown Hotties Competition
                                     Alpha Media Group Inc.
                                 415 Madison Avenue, 3rd Floor
                                      New York, NY 10017

       Only women who return the completed Pre-Publication Affidavit are eligible to become
Selected Entrants as defined by the Official Rules. We will select up to 100 women who return
completed Pre-Publication Affidavits to become Selected Entrants; not all Preliminary Selected
Entrants will be selected as Selected Entrants.

        AMG cannot accept telephone inquiries. If you have any questions about the Official Rules
or any of the forms, you may e-mail hometownhotties@maxim.com. AMG will make every effort
to respond to all inquiries as soon as possible. Please include your email address under which you
registered.

Remember, we cannot be held responsible for delays in the mail, so give yourself plenty of time.
              PRE-PUBLICATION AFFIDAVIT OF ELIGIBILITY AND RELEASE
Dated: ______________________, 2011

State/Province of                                               )
                                                                )
County of                                                       )


         Legal Name:                                  , being duly sworn, does hereby depose and say:


1.       I am a female, 21 years old or older and am a legal resident of a state of the United States of America or a

province of Canada (other than Quebec). My date of birth is ___________________________________________.

2.       The following are all of the names that I have used professionally or personally:

________________________________________________________________________________________________

________________________________________________________________________________________________

_______________________________________________________________________________________________.


3.     The Entrant Identification Number that was provided to me when I entered the Competition is
________________.

4.       I reside at                                                              .

_________________________________________________________________

_________________________________________________________________

My home telephone number is                            .

My work telephone number is                                     .

My cell phone number is ______________________________.

My e-mail address is                                                     .

My social security number is ______________________________. (US Residents Only.)

In the event that any of the above information changes, I shall contact the Competition Entities (defined below)
immediately.

5.        I am an entrant in the 2011 Hometown Hotties Competition (the “Competition”). I hereby affirm the
covenants, warranties and representations that I made when I entered the Competition, including those included but not
limited to those included in the License Agreement that I executed. I further warrant and represent that I have read and
do understand and agree to comply with the Official Rules of the Competition, located on the World Wide Web at
www.maximonline.com. I certify that I personally entered the Competition.
2011 Hometown Hotties Competition                                        Entrant’s Affidavit and Release
Entrant ID# _______________


6.     Neither I nor any member of my family is an employee of Alpha Media Group Inc. (“AMG”), or its parent
companies, subsidiaries, affiliates nor their advertising and production companies.

7.       I certify that: (i) I have not won any sweepstakes, contest or competition sponsored by AMG, and in particular
that I was not voted one of the ten (10) finalists in any prior Hometown Hotties Competition; and (ii) I am not currently
competing in any other sweepstakes, contest or competition sponsored by the Competition Entities which requires the
submission of my photograph. I understand that if I enter such a sweepstakes, contest or competition while this
Competition is ongoing, I may be declared ineligible in this Competition.

8.         I certify that, at no time, has my image been published in any media (print publications, World Wide Web,
television, etc.) in a manner that is pornographic, vulgar or obscene. I further agree that I will not permit the publication
of my image in any media (print publications, World Wide Web, television, etc.) in a manner that is pornographic,
vulgar or obscene during the Competition or, if I am selected as a Semi-Finalist in the Competition, for a period of one
(1) year after the announcement of the 2011 Winner. I understand that the determination of whether my image has or
has not been published in a manner that is pornographic, vulgar or obscene is within the sole discretion of AMG and
that if I do not comply with this rule, I may be ineligible to compete or disqualified.

9.       I certify that, at no time, has my image been published in any media (print publications, World Wide Web,
television, etc.) that competes with MAXIM Magazine or the Competition, or with any brand expansion of Maxim, and
agree that it will not be so published during the Competition. I understand that if I do not comply with this rule, I may
be disqualified, as determined in the sole discretion of AMG.

10.      I hereby consent to AMG, by itself or through its agents, to conduct a background check on me, to verify
information that I provided or heretofore may provide, to verify my compliance with the Official Rules, or for other
reasons related to the Competition.

11.       I have entered the Hometown Hotties Competition in the following years (check all that are applicable):
________ 2010 ______ 2009 ______ 2008 ______ 2007 ______ 2006 ______ 2005 ______2004 ______ none
(first time entrant)


12.       I certify that any video I submit, which is required for Semi-finalists, (the “Submitted Video”) will have been
shot at a date after July 1, 2010, and that I was 21 years old or older on the date that the earliest portion of the Submitted
Video was shot.

13.      I understand and acknowledge that in order to become a Semi-Finalist, Finalist and/or Winner of the
Competition, I may be required to submit additional materials (including but not limited to affidavits, photographs,
additional videotapes (in addition to the aforementioned Submitted Assets), releases and responses to questionnaires),
submit to interview(s), and/or appear at photo shoots. I further understand and acknowledge that my failure or inability
to do any of the foregoing, my failure to respond to inquiries made by AMG in the time requested, or the inability to
reach me at the e-mail address and/or telephone number provided, shall be immediate grounds to disqualify me from
further participation in the Competition.

14.      I certify that I have not committed any fraud or deception in entering or participating in the Competition.

15.      I certify that all answers to questions posed by AMG, whether in the form of a questionnaire or a personal
interview, are truthful to the best of my knowledge, information and belief.

16.     I certify that the photographs that I have submitted with my entry into the Competition (the “Submitted
Photographs”) are photographs of me and were taken at a date after July 1, 2010, and that I was 21 years old or older on




                                                                                                  ______________
                                                                                                   Entrant’s Initials
2011 Hometown Hotties Competition                                        Entrant’s Affidavit and Release
Entrant ID# _______________


the date that the earliest of the Submitted Photographs was taken. I further certify that I was at least age 21 in all of the
other photos that I submitted to AMG that were used as part of my self-promotion.

17.        I certify that I have attached to this Pre-Publication Affidavit a true and accurate photocopy of two forms of
identification of myself, and that I have presented originals of these documents to the Notary Public for her/his review.
I certify that at least one of the forms of identification is a valid government-issued ID that includes my date of birth and
photograph (such as a driver's license, passport, or state/provincial identification card). I further certify that the other
form of identification verifies my identity (such as school or employer identification card, social security card, or birth
certificate). I understand that failure to include such identification will render me ineligible to participate in the
Competition.

18.       I acknowledge and understand that I am responsible for the reporting and payment of any applicable federal,
state, local or other taxes imposed should I receive a prize in the Competition.

19.       I represent and warrant that I have all the rights in and to the Submitted Assets necessary to grant AMG the
rights granted herein. In particular, and without limiting the foregoing, I represent and warrant that I am the holder of
the copyright in the Submitted Assets, or that I otherwise have the right to reproduce and publish the Submitted Assets.
If I do not personally own the copyright to the Submitted Assets, I represent and warrant that the respective
copyright holders have granted me the right to allow AMG to reproduce the Submitted Assets, and to publish
the Submitted Assets as set forth in the Official Rules and/or herein. If a photographer/videographer or any
other third party owns the copyrights to the Submitted Assets (the “Copyright Holders”), I understand that I
must provide a Copyright Release (which was attached to the same e-mail that contained this affidavit) signed by
the Copyright Holder(s), or I will be ineligible to participate in the Competition. I am responsible for any
financial reimbursement to the original Copyright Holder for the rights to publish the Submitted Assets; AMG
will not be responsible for any such payment. I agree to hold AMG harmless and to indemnify and defend AMG
from any and all liabilities, loss, claims, or causes of actions, including reasonable attorneys’ fees and expenses
that may be incurred by AMG, arising out of or relating to my breach of any of the foregoing covenants,
representations and warranties.



ENTRANT MUST INITIAL HERE


                                                                                                                    _________
                                                                                                                    INITIAL

20.       I waive (or shall ensure that the Copyright Holder(s) referred to above shall waive) in favor of AMG and
anyone authorized by them, any and all moral rights that I or Copyright Holder(s) may have in any photograph or video
that I submit.

ENTRANT MUST INITIAL HERE


                                                                                                                    _________
                                                                                                                    INITIAL



21.      I understand that I have the right to submit additional photos as part of my self-promotion, and that I may also
be required to provide additional photographs and/or a videotape of myself (collectively, the “Additional Submitted




                                                                                                  ______________
                                                                                                   Entrant’s Initials
2011 Hometown Hotties Competition                                      Entrant’s Affidavit and Release
Entrant ID# _______________


Materials”), and such Additional Submitted Materials shall be included for purposes of this affidavit and release in the
definition of Submitted Assets. I represent, warrant and understand that I must and shall have all the rights in and to the
Additional Submitted Materials and that such Additional Submitted Materials shall be subject to the same restrictions,
warranties, representations and covenants applicable to all Submitted Assets.


ENTRANT MUST INITIAL HERE


                                                                                                                  _________
                                                                                                                  INITIAL

22.       For good consideration, the receipt and sufficiency of which is acknowledged, I hereby grant to AMG and its
affiliated domestic and foreign publishing companies and licensees (“Affiliate(s)”) the irrevocable right and permission
to use, re-use, publish, re-publish and otherwise reproduce and display (collectively “Publish(ed)”) the photographs,
videotape and other materials that I have heretofore submitted or may hereafter submit as part of the Competition,
including but not limited to the Submitted Assets, and my biographical information (including my name, home town,
state, and the content of my biography) and responses to any questionnaire not specifically and in writing indicated to
be confidential or anonymous (collectively, the “Biographical Information”) that I submitted upon my entry into the
Competition or that I may hereafter submit as part of the Competition for use by AMG and Affiliates as permitted
herein. Such right and permission shall include the right to adapt, crop, revise and edit any of the Submitted Materials
and to edit any of my Biographical Information for clarity, brevity and for conformity with AMG’s editorial standards,
and to Publish and distribute the Submitted Assets, Additional Submitted Materials and Biographical Information, as
well as my name and likeness throughout the world and in perpetuity, in whole or in part and in conjunction with other
photographs or videos, in any and all media now known or hereafter devised, in connection with the following: (a) the
United States edition of MAXIM Magazine (“MAXIM Magazine”) and supplements packaged and sold in conjunction
therewith; (b) domestic and foreign Affiliate publications; (c) AMG’s websites and respective Affiliate websites as well
as on other media platforms, including but not limited to WAP, mobile and wireless media platforms, that permit the
Submitted Assets, Additional Submitted Materials and Biographical Information to be uploaded or downloaded; (d)
collections of MAXIM Magazine and Affiliate materials not distributed for sale; (e) television broadcast, including, but
not limited to, the right to license or distribute the Submitted Assets, Additional Submitted Materials and Biographical
Materials via broadcast or cable outlets; (f) home video and/or film use, including, but not limited to, the right to
manufacture copies of the Submitted Assets, Additional Submitted Materials and Biographical Materials in all video
and DVD formats for rental or sale to consumers for viewing; (g) video on demand, including, but not limited to,
offering the Submitted Assets, Additional Submitted Materials and the Biographical Materials for exhibition to
consumers on a pay-per-view basis; (h) Internet use, including, but not limited to, offering the Submitted Assets,
Additional Submitted Materials and Biographical Material for exhibition to consumers via the Internet; (i) advertising,
promoting and publicizing, in any and all media, the publications and materials referenced herein (including, but not
limited to, the Competition and any subsequent AMG or Affiliate-sponsored competitions); (j) on cell phones and other
media platforms that permit the Submitted Assets to be uploaded and/or downloaded, and (k) other commercial
purposes (including, but not limited to, calendars, posters, or usage by third parties).

Without additional compensation, I further grant AMG (and any designee of AMG) the irrevocable right and permission
to photograph me and to record my image, likeness and voice in audio and/or video or digital format (the “Additional
Materials”) and to Publish such Additional Materials for use by AMG as permitted herein. Such right and permission
shall include the right to adapt, crop, revise and edit any of the Additional Materials, and to Publish and distribute the
Additional Materials, as well as my name and likeness throughout the world and in perpetuity, in whole or in part and in
conjunction with other photographs or videos, in any and all media now known or hereafter devised, in connection with
the following: (a) the United States edition of MAXIM Magazine (“MAXIM Magazine”) and supplements packaged
and sold in conjunction therewith; (b) domestic and foreign Affiliate publications; (c) AMG’s websites and respective
Affiliate websites as well as on other media platforms, including but not limited to WAP, mobile and wireless media




                                                                                                ______________
                                                                                                 Entrant’s Initials
      2011 Hometown Hotties Competition                                       Entrant’s Affidavit and Release
      Entrant ID# _______________


      platforms, that permit the Submitted Assets, Additional Submitted Materials and Additional Materials to be uploaded or
      downloaded; (d) collections of MAXIM Magazine and Affiliate materials not distributed for sale; (e) television
      broadcast, including, but not limited to, the right to license or distribute the Submitted Assets, Additional Submitted
      Materials and Additional Materials via broadcast or cable outlets; (f) home video and/or film use, including, but not
      limited to, the right to manufacture copies of the Submitted Assets, Additional Submitted Materials and Additional
      Materials in all video and DVD formats for rental or sale to consumers for viewing; (g) video on demand, including, but
      not limited to, offering the Submitted Assets, Additional Submitted Materials, Additional Materials for exhibition to
      consumers on a pay-per-view basis; (h) Internet use, including, but not limited to, offering the Submitted Assets,
      Additional Submitted Materials and Additional Materials for exhibition to consumers via the Internet; (i) advertising,
      promoting and publicizing, in any and all media, the publications and materials referenced herein (including, but not
      limited to, the Competition and any subsequent AMG or Affiliate-sponsored contests); (j) on cell phones and other
      media platforms that permit the Submitted Assets, Additional Submitted Materials and Additional Materials to be
      uploaded and/or downloaded; and (k) other commercial purposes (including, but not limited to, calendars, posters or
      usage by third parties).

23. I understand that, except as specifically set forth in the Rules and described herein, I have no right to identify myself as
a participant in the Hometown Hotties Competition or to use any of AMG’s trademarks or tradenames (including but not
limited to MAXIM and HOMETOWN HOTTIES). I understand that, in accordance with the Official Rules:

                        Unless I am selected as a Semi-Finalist, I have no right to identify myself as a participant in the 2011
                         Hometown Hotties Competition, or to otherwise use any of AMG’s trademarks or tradenames
                         (including but not limited to MAXIM and HOMETOWN HOTTIES).

                        If I am selected as a Semi-Finalist, I may refer to myself as a “2011 Maxim Hometown Hotties Semi-
                         Finalist” solely in written and descriptive materials such as a biography, resume, or other purely
                         noncommercial descriptive materials. I understand that, if I am selected as a Semi-Finalist, I will not
                         have the right to license the Competition Entities’ name or trademarks, including but not limited to
                         MAXIM or HOMETOWN HOTTIES, to any other entity, or to otherwise authorize or permit any
                         such use, even if I am making an appearance on behalf of such entity. Any use of “Maxim,”
                         “Hometown Hotties,” or any other trademark or trade name associated with AMG in connection with
                         a promotional event or advertising must be approved in advance and in writing by AMG.

                        If I am selected as a Finalist, I may refer to myself as a “2011 Maxim Hometown Hotties Finalist”
                         solely in written and descriptive materials such as a biography, resume, or other purely
                         noncommercial descriptive materials. I understand that, if I am selected as a Finalist, I will not have
                         the right to license AMG’s name or trademarks, including but not limited to MAXIM or
                         HOMETOWN HOTTIES, to any other entity, or to otherwise authorize or permit any such use, even
                         if I am making an appearance on behalf of such entity. Any use of “Maxim,” “Hometown Hotties,” or
                         any other trademark or trade name associated with AMG in connection with a promotional event or
                         advertising must be approved in advance and in writing by AMG.

                        If I am selected as a Potential Finalist, I will be provided with one (1) photograph (the “Licensed
                         Photograph”) and a videotape (the “Licensed Video”) from the Finalist Photo/Video Shoot, such
                         Licensed Photograph and Licensed Video to be selected in the sole discretion of AMG. I shall have
                         the right to use such Licensed Photograph and Licensed Video on my portfolio and personal
                         promotional site online, provided that such online site does not include any photos that are considered
                         pornographic, vulgar or obscene (which is to be determined in the sole discretion of AMG). The
                         Licensed Photograph and Licensed Video will have a watermark with the Maxim Digital logo, and
                         will include a credit for the photographer, and must be used in connection with these logos and
                         credits. The Licensed Photograph and Licensed Video may not be used for any purpose other than
                         those described herein without the prior express written permission of AMG.




                                                                                                       ______________
                                                                                                        Entrant’s Initials
2011 Hometown Hotties Competition                                     Entrant’s Affidavit and Release
Entrant ID# _______________



                 If I am selected as the Winner, I may refer to myself as the “2011 Maxim Hometown Hotties Winner”
                  solely in written and descriptive materials such as a resume or other purely noncommercial
                  descriptive materials. I understand that, if I am selected as the Winner, I will not have the right to
                  license AMG’s name or trademarks, including but not limited to MAXIM or HOMETOWN
                  HOTTIES, to any other entity, or to otherwise authorize or permit any such use, even if I am making
                  an appearance on behalf of such entity. Any use of “Maxim,” “Hometown Hotties,” or any other
                  trademark or trade name associated with AMG in connection with a promotional event or advertising
                  must be approved in advance and in writing by AMG.

24.       I understand that the Competition may be promoted by or in connection with other sponsors, including but not
limited to beer or liquor companies. I hereby specifically grant such sponsors the right to use the Submitted Materials,
Additional Materials and other materials referred to herein in connection with such promotions without additional
compensation.

25.      I understand that if I am selected as a Finalist, I may be required to participate in a video shoot on behalf of
AMG or a third-party advertiser to be selected in the sole discretion of AMG, to participate in promotional events on
behalf of advertisers selected at the sole discretion of AMG, and to host one or more parties on behalf of the AMG
and/or advertisers , all without additional compensation (except that transportation and hotel accommodations may be
provided at the sole discretion of AMG). I hereby agreed to the foregoing. Further, I understand that if I am selected as
the Winner, I must agree to appear on a poster to be included inside a 2011 or 2012 issue of Maxim Magazine, and I
acknowledge and agree that such poster may be sponsored by one or more of AMG's advertisers including its liquor and
tobacco sponsors; and I hereby agree to the foregoing.


26.      I hereby release AMG and its parent companies, affiliates, subsidiaries, officers, directors, employees,
licensees, agents, successors and assigns from any and all claims whatsoever in connection with the use, as permitted
herein, of the Submitted Assets, the Additional Materials, as well as my name and likeness. I hold AMG harmless, and
will indemnify and defend AMG from any and all liabilities, loss, claims, or causes of actions, including reasonable
attorneys’ fees and expenses that may be incurred by AMG, arising out of or relating to my breach of any covenant,
representation or warranty contained herein, or any other breach of the Official Rules.

27.      I understand and acknowledge that AMG is under no obligation whatsoever to use any of the Submitted
Assets, Additional Submitted Materials, the Biographical Information, the Additional Materials or my name or likeness.
I also understand and acknowledge that I have no right to approve or inspect the Submitted Assets, Additional
Submitted Materials, the Biographical Information, the Additional Materials or any content that relates or refers to the
Submitted Assets, Additional Submitted Materials or Additional Materials prior to publication.

28.       I understand and hereby acknowledge that this Pre-Publication Affidavit shall be governed by and interpreted
under the laws of the State of New York, and that the courts of New York County, within the State of New York shall
have exclusive jurisdiction over any claim or matter relating to or arising under this agreement. In the event of any
claimed breach of this Pre-Publication Affidavit, it is expressly agreed that my sole remedy shall be to seek damages
and that in no event shall I be entitled to seek or obtain any injunctive or other equitable relief.

29.      I understand and acknowledge that AMG is relying upon my consent and agreement as provided hereunder, to
exercise the rights granted hereunder. In the event that AMG determines or believes that I have engaged in
misrepresentation or breached any representation or warranty contained herein, in addition to any other legal remedies,
AMG may, in its sole and absolute discretion, disqualify my entry in the Competition and remove or delete the
Submitted Assets, Additional Submitted Materials, Additional Materials, or my name and likeness from its publications.
This Agreement contains the entire understanding and agreement between the parties regarding the subject matter
herein. This Agreement cannot be modified or amended except by a writing executed by the parties.




                                                                                              ______________
                                                                                               Entrant’s Initials
2011 Hometown Hotties Competition                                      Entrant’s Affidavit and Release
Entrant ID# _______________



____________________________________                            ____________________________________
Signature                                                       Street Address

_____________________________________                           ___________________________________
Print Name                                                      City, State, and Zip/Postal Code




                                             NOTARY’S CERTIFICATE

The undersigned certifies that on the ___ day of ____________, 2011 before me personally came
________________________, who executed this document before me and presented to me two (2) original forms of
identification, one of which is an official government-issued identification including her date of birth and a photograph,
which is consistent with her appearance, and the second of which verifies her identity.


____________________________________
Notary Public




                                                                                               ______________
                                                                                                Entrant’s Initials

				
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