This document when signed and returned will serve as a release from liability
I acknowledge that my participation in The WTLC-AM “Family Comedy Tour Opening Act Contest” (“Contest”) is voluntary and solely at my own risk.
I hereby state that I have no medical condition, am not under a doctor’s care for any medical condition and require no regularly scheduled medication that would prohibit me from participating in the Contest as described in the Official Contest Rules.
In case of an emergency, please contact ______________________________________at ____________________________.
In consideration of my participation in the above-referenced Contest, I agree:
• To release WTLC-AM, Radio One of Indiana, LP, its parent, officers, directors, subsidiaries, affiliates, general sponsors, and any other promotional partners involved in the this Contest (the “Promotional Parties”), and their respective parent companies, subsidiaries, affiliates, directors, officers, stockholders, owners, employees, agents, successors and assigns from any injury, harm, damage, personal or otherwise, demands, causes of action, liability, cost or expense whatsoever that I may suffer, directly or indirectly, from my participation in this Contest.
• That as a Contest participant, I am qualified to participate in the competition for a chance to win the grand prize of five (5) minutes of performance time as the opening act for the 2010 Family Comedy Tour stop in Indianapolis, IN.
• That my participation constitutes permission to broadcast and/or record some or all portions of the competition. This release also constitutes permission to use my name, voice, submitted entry, or likeness in any advertising or broadcasting media now known or hereafter devised related to this Contest, for promotion purposes throughout the world in perpetuity.
• To fully and forever release, acquit, and discharge the Promotional Parties, their respective parents, subsidiaries, affiliates and sponsors, and its officers, directors, employees, agents, assigns, attorneys, licensees, affiliates and sponsors from any and all liabilities, claims, demands, actions, causes of action, and rights, whether contingent, accrued, inchoate, or otherwise, relating to, or arising out of, the use, publication, distribution, reproduction, or display of my name, photograph, voice, submitted entry, performance, image or other likeness, and such release shall be binding upon my heirs, successors, assigns, and representatives.
If I become the grand prize winner in this Contest, I understand that I will be responsible for any and all taxes which may be payable (including but not limited to, income tax, sales tax, or use tax, if any) as the result of the receipt by me of this item. I understand that I will be issued an IRS Form 1099 for this prize if the value amount exceeds $600 and for that limited purpose I will supply my social security number in the space provided below on this form.
I ACKNOWLEDGE THAT I HAVE READ AND UNDERSTAND THIS RELEASE FORM, AND I AGREE TO THE TERMS HEREIN.
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Last Name First Name Soc. Sec. Number
(Please Print)
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Street Address City State Zip Code
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Phone Number Email Address
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Age Date Signature
The winner will be sharing a stage with Marcus D. Wiley Griff, Small Fire and Chris Clark! Send your embed code to your video to tlcnaptown@gmail.com
THE OFFICIAL RULES
http://praiseindy.com/files/2010/11/RULES-WTLC-AM-Family-Comdey-Tour-clean.pdf
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