Affidavit of Eligibility and Liability and Publicity Release

Sweepstakes Name(Required)

Full Name(Required)

First Last

Email(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Date of Birth(Required)

Telephone-Day(Required)

Telephone-Evening(Required)

Driver License State(Required)

Driver License Number(Required)

I, (Full Name)(Required)

First Last

All must be reviewed and checked to be eligible to receive the prize(s).

hereby represent, warrant and agree that:(Required)

1) I am a legal resident of the State of Arizona.‎

2) I am at least twenty-one (21) years old.‎

3) I am not an employee of the Sponsor or any of its subsidiaries, affiliates, directors, officers, owners, employees or agents, nor am I a spouse, parent, sibling or child of any of the foregoing.‎

4) I represent that I am eligible to receive the prize awarded to me in the Contest and satisfy all eligibility requirements set forth in the official rules for the Contest, which I acknowledge having read and understood, and any other requirements imposed by law. I have complied with all Contest rules and have not committed any fraudulent act in connection with entering the Contest or claiming any prize.‎

5) On behalf of myself, my heirs and personal representatives, I hereby release the Sponsor and each of its subsidiaries, affiliates, directors, officers, owners, employees and agents from any liability whatsoever and waive any and all causes of action related to any claims, costs, injuries, losses or damages of any kind arising out of or in connection with my participation in the Contest or the any prize (including, without limitation, claims, costs, injuries, losses and damages related to personal injuries, death, damage to or destruction of property, rights of publicity, privacy or defamation, whether intentional or unintentional), under contract, tort (including negligence) or any other theory of law.‎

6) I understand that I am entitled to receive only the prize that is awarded by the Sponsor and that each such prize is nontransferable. BY SIGNING BELOW, I ACKNOWLEDGE RECEIPT OF THE PRIZE TO WHICH I AM ENTITLED.‎

7) I understand that I am responsible for all costs I incur in connection with the Contest and/or the award or use of any prize including, without limitation, all federal, state, local and other taxes on the prizes awarded.‎

8) I ACKNOWLEDGE AND AGREE THAT ALL PRIZES ARE AWARDED BY THE SPONSOR “AS IS” AND THAT THE SPONSOR MAKES NO WARRANTY OR REPRESENTATION OF ANY KIND, EXPRESS OR IMPLIED, INCLUDING ANY WARRANTY OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE, WITH RESPECT TO ANY PRIZE. I ASSUME ALL RISK OF LOSS AND/OR LIABILITY ASSOCIATED WITH THE PRIZES AND IN NO EVENT SHALL THE SPONSOR HAVE ANY LIABILITY TO ME, MY HEIRS OR PERSONAL REPRESENTATIVES FOR ANY INJURY OR LOSS ARISING FROM MY USE OF THE PRIZES.‎

9) On behalf of myself, my heirs and personal representatives, I hereby grant permission to the Sponsor and its respective subsidiaries, affiliates, directors, officers, governors, owners, employees and agents to use my voice, name, image, likeness, actions, statements and photographs for advertising and promotional purposes without further authorization, compensation, remuneration or notification.‎

All must be reviewed and checked to be eligible to receive the prize(s).

Prize Being Awarded(Required)

Today's Date(Required)

Electronic signature(Required)

By signing this Affidavit, you agree your electronic signature is the legal equivalent of your manual/handwritten signature. You further agree that your signature on this document (hereafter referred to as your "E-Signature") is as valid as if you signed the document in writing. You also agree that no certification authority or other third-party verification is necessary to validate your E-Signature. You agree that you have read, understood and consented to this Affidavit and all information provided is true and correct.

CAPTCHA

HOW CAN WE SERVE YOU?

We’d love to hear from you.

OFFICE HOURS: