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Zbar Publicity Release/Affidavit of Eligibility/Liability Release Form - Sweepstakes #81 - Zanzabar
In order for us to deliver your prize, we need you to agree and submit the Publicity Release/Affidavit of Eligibility/Liability Release Form below.
next to each field label means that an entry in this field is required.
Phone (include area code)
Prize Suppler: Zanzabar Nightclub Sponsor: Zanzabar Nightclub Prize: $175.00 VIP ZCardPrize Value: Up to $$175.00 Region: Open only to legal residents of the State of Hawaii ** Date: 6/14/2013
I give permission for my name, likeness, image, voice, and/or appearance as such may be embodied in any pictures, photos, video recordings, audiotapes, digital images, and the like either provided by me or taken by sponsor, Ernest Abrams, MacBusiness Consulting and/or Prize Supplier to be used without compensation, etc. from Sponsor, Ernest Abrams, MacBusiness Consulting and/or Prize Supplier for Web pages, advertising and/or promotional purposes.
Your name and image will only be used as being the winner of the contest/sweepstakes.
By submitting this form, I am expressly releasing Sponsor, Ernest Abrams, MacBusiness Consulting and/or Prize Supplier, its agents, employees, licensees and assigns from any and all claims which I may have for invasion of privacy, right of publicity, defamation, copyright infringement, or any other causes of action arising out of the use, adaptation, reproduction, distribution, broadcast or exhibition of such pictures, photos, video recordings, audiotapes, digital images, and the like.
Check here if you agree to publicity release.
Affidavit of Eligibility
I certify I was eligible at the time of the entry for the sweepstakes, contests, giveaway defined above base on the eligible requirements defined below:
Eligibility Requirements: Open only to legal residents of the region defined in definitions above and who are 18 years of age at the time of entry and is void wherever prohibited or restricted by applicable federal or state laws and regulations. Employees of the Sponsor and/or supplier of the prize, and their respective parent companies, subsidiaries, affiliates, officers, directors, agents, employees, advertising, provider of prize and promotion agencies and members of their immediate families (spouses, parents, children, and siblings and their spouses) are not eligible. For purposes of determining eligibility and awarding of prizes, entry will be declared made by the "authorized e-mail account holder". "Authorized e-mail account holder" is defined as the natural person who is assigned to an e-mail address by an Internet access provider, online service provider or other organization (e.g., business, educational institution etc.) that is responsible for assigning e-mail addresses for the domain associated with the submitted e-mail address. Participant may be requested to provide Sponsor with proof that the participant is the authorized e-mail account holder of the e-mail address associated with the account/submission. Proof of submitting entries will not be deemed to be proof of receipt by Sponsor.
Check here if you certify eligilibility.
BY ACCEPTING THE PRIZE, THE WINNER AGREES THAT THE SPONSOR(s), ERNEST ABRAMS, MACBUSINESS CONSULTING, PRIZE SUPPLIER(s) [ITS/THEIR] SUBSIDIARIES, AFFILIATES, ADVERTISING AND PROMOTION AGENCIES, AND ALL OF THE SPONSOR'S OFFICERS, DIRECTORS, EMPLOYEES, REPRESENTATIVES AND AGENTS, WILL HAVE NO LIABILITY WHATSOEVER FOR, AND WILL BE HELD HARMLESS BY WINNER FOR ANY LIABILITY FOR ANY INJURY, LOSS OR DAMAGES OF ANY KIND TO PERSONS, INCLUDING DEATH, AND PROPERTY, DUE IN WHOLE OR IN PART, DIRECTLY OR INDIRECTLY, FROM THE ACCEPTANCE, POSSESSION, USE OR MISUSE OF THE PRIZE OR PARTICIPATION IN THIS SWEEPSTAKES OR PARTICIPATION IN ANY SWEEPSTAKES OR PRIZE RELATED ACTIVITY. Subject to all federal, state and local laws. Void where prohibited.
Check here if you
agree to liability release.
Authorization Signature Code
Please enter unique signature code emailed to you
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