Alaska Airlines Cheer on the Dawgs in Atlanta Sweepstakes Affidavit of Eligibility, Liability & Publicity Release

Transcription

1 Alaska Airlines Cheer on the Dawgs in Atlanta Sweepstakes Affidavit of Eligibility, Liability & Publicity Release STATE OF COUNTY OF Alaska Airlines, Inc. ( Sponsor ) is the sponsor of the Alaska Airlines Cheer on the Dawgs in Atlanta Sweepstakes ( Promotion ). This Affidavit of Eligibility, Liability & Publicity Release ( Affidavit ) will be used by Prize Logic, LLC ( PrizeLogic ) to verify my eligibility to receive the first prize ( Prize ). The Approximate Retail Value ( ARV ) of the Prize is $3, I, (print complete name), being duly sworn, depose and say: I am submitting this Affidavit at the Sponsor s request and to comply with the requirements of the Official Rules of the Promotion ( Official Rules ). I recognize that this Affidavit hereby serves as official notification that I am a potential first prize winner in the Promotion. I understand that I must sign this Affidavit before a notary public and return it to PrizeLogic. Further, I agree that the notarized Affidavit must be received by PrizeLogic no later than 24 hours from the date the winner notification was sent to me or the Prize may be forfeited and awarded to an alternate winner. Further, if the Prize is forfeited and awarded to an alternate winner, I will not receive any compensation nor will I be awarded any prize. I must send the notarized Affidavit within such time to: PrizeLogic: Or as a PDF to AlaskaAirGoDawgs@prizelogic.com Should my eligibility be verified, I understand that the Prize I will receive is: 2 round-trip coach Alaska Airlines tickets between Atlanta, GA at specific flight times selected by Sponsor leaving on December 30, 2016 from Seattle-Tacoma International Airport, Seattle, WA and returning on January 1, 2017, 2 Nights hotel accommodations, double occupancy in Atlanta, GA, check in on December 30, 2016 and checkout on January 1, 2017, ground bus transportation to and from the Atlanta, GA airport, ground bus transportation to and from the hotel to the football game in Atlanta, GA, admission for 2 to a football game in Atlanta GA on December 31, I understand and acknowledge that the Prize is subject to all of the terms, conditions, and restrictions set forth in the Official Rules. I represent and warrant that I have complied fully with all of the Official Rules, a copy of which I received with this Affidavit; that my entry into the Promotion complies with the Official Rules; and that I have not committed, nor been party to, nor had knowledge of the commission of any fraud, deception, or misrepresentation in connection with my participation in the Promotion. I represent and warrant that as

2 of the date I entered this Promotion and date of this Affidavit, I was and am not an employee (nor is or was a member of my immediate family or household, whether or not related, i.e., spouse, parent, child, sibling, grandparent and the steps of each and their respective spouses, regardless of where they reside, and their household members) of Sponsor, PrizeLogic, or any of their respective parent companies, subsidiaries, affiliates, advertising, promotion, or web design agencies (collectively, Promotion Entities ). I further represent and warrant that I am a legal United States resident physically residing in legal resident of the United States, residing in the State of Washington and are at least 18 years of age at the time of entry. I represent and warrant that all of the information I have provided and will provide in connection with this Promotion has been and will be true, accurate and complete, and I have not attempted to, sought to, or done anything to influence the outcome of the Promotion other than by entering and participating in accordance with the Official Rules. If any statement made by me in this Affidavit is false, then, in addition to any other remedies that may be taken against me, I agree to return to the Sponsor any prize awarded to me. Publicity Release In consideration of my receipt of the Prize, I hereby grant to Sponsor and its designated agents and representatives the right, without limitation, to use my name, biographical information, photos and/or likeness, entry, and statements for promotion, trade, commercial, advertising, and publicity purposes, at any time or times, in all media now known or hereafter discovered, world-wide, including, but not limited to, on the World Wide Web and Internet, without notice and without additional compensation except where prohibited by law. I also agree that such use can be made without my inspection, review, or approval of any materials used in connection with it. Release of Liability In further consideration of my receipt of the Prize, on behalf of myself, my heirs, executors, administrators and assignees, I hereby release and hold harmless the Promotion Entities and each of their respective officers, directors, employees, representatives and agents from all liability and responsibility for any and all claims, damages, losses and liabilities of any nature whatsoever that I or any of the aforementioned parties may now or hereafter be entitled to assert, including, but not limited to any death, property damage, injury, loss of enjoyment or other harm or loss of any nature whatsoever caused or arising out of my participation in the Promotion and/or acceptance, use, or misuse of the Prize. I also acknowledge that, except as specifically provided herein or in the Official Rules, the Promotion Entities have neither arranged for nor carry any insurance of any kind for either me or any of the aforementioned parties benefit relating to my acceptance and/or participation and enjoyment in any aspect of the Prize and that I am solely responsible for obtaining and paying for any such insurance. I voluntarily accept the Prize awarded to me with the knowledge of all risks of acceptance. I accept, at my own risk, and take sole and absolute responsibility for any injuries arising or damages incurred out of the use, misuse, or acceptance of the Prize, including, without limitation, the risk of personal injury or death, and I shall not hold the Promotion Entities responsible. Further, I agree to waive all of rights to bring any claim, action or proceeding against any of the Promotion Parties in connection with the Promotion.

3 I hereby expressly accept the Prize, as more fully described in the Official Rules and herein, with the full knowledge and understanding that all applicable federal, state, and local income or other taxes resulting from my acceptance of the Prize shall be solely my responsibility, and that neither Sponsor nor any other party associated with this Promotion shall have any responsibility for any portion of such tax liability. Further, I understand and acknowledge that I will be issued a form 1099 for tax purposes in the amount of the actual retail value of the Prize, and I must submit my Social Security Number, as required by law.

4 I do hereby state and acknowledge that by signing below I understand and agree to be legally bound by all of the statements, terms, and conditions contained herein. (Please Initial) (Please Initial) I have read and agree to be bound by the Official Rules, a copy of which is attached. I acknowledge I will receive a federal tax form 1099 stating the actual retail value of the Prize. Winner s Complete Legal Name (Please Print) Winner s Address Winner s Social Security Number Winner s Phone Number(s) Winner s Date of Birth (MM/DD/YYYY) Home Address (Street Address, City, State, ZIP) Employer (Name, Street Address, City, State, ZIP) Cell: Home: Winner s Signature Date You are required to have a notary public verify your identification and sign below. STATE OF COUNTY OF On this, the day of, 2016, before me a notary public, the affiant, personally appeared, known to me (or satisfactorily proven by presentation of photo identification) to be the person whose name is subscribed to within this document, and acknowledged that he/she executed the same for the purposes stated therein. Sworn To Before Me This Day, 2016 Notary Signature My Commission Expires:

5 Alaska Airlines Cheer on the Dawgs in Atlanta Sweepstakes TRAVEL COMPANION LIABILITY & PUBLICITY RELEASE STATE OF COUNTY OF I, (print complete name), being duly sworn, do hereby state as follows: I have been selected by (Insert Name of Winner), the Prize Winner in the Alaska Airlines Cheer on the Dawgs in Atlanta Sweepstakes ( Promotion ) sponsored by Alaska Airlines, Inc. ( Sponsor ) to be a guest to participate and enjoy in the travel aspects of the trip portion of the first prize. Consistent with the Official Rules of the Promotion, I submit this Travel Companion Liability & Publicity Release ("Agreement & Release") to Prize Logic, LLC ( PrizeLogic ), to determine whether I am eligible to be the Prize Winner s travel companion ( Guest or Travel Companion ) for the trip portion of the Prize. In consideration of my being the Prize Winner's Guest, on behalf of myself, my heirs, executors, administrators, and assignees, I hereby release and hold harmless Sponsor, PrizeLogic, and all other entities associated with this Promotion, and each of their respective parents, subsidiaries, affiliated companies, distributors, licensees, manufacturers, web design, advertising, fulfillment, or promotion agencies involved in the administration, development, fulfillment or execution of the Promotion and each of their respective officers, directors, employees, representatives, and agents (collectively, Promotion Entities ) from and against all claims, damages, losses, and liabilities of any nature whatsoever that I or any of the aforementioned parties may now or hereafter be entitled to assert, including, but not limited to, any death, property damage, injury, loss of enjoyment, or other harm or loss of any nature whatsoever caused by or arising out of my participation in the Promotion and participation in the travel portion of the Prize. I also acknowledge that the Promotion Entities have neither arranged for nor carry any insurance of any kind for either my benefit or the benefit, of any of the aforementioned parties, relating to my acceptance, participation, travel, attendance, enjoyment, and/or use or misuse of any aspect of the Prize, and that I am solely responsible for obtaining and paying for any such insurance. Further, I agree to waive all of rights to bring any claim, action or proceeding against any of the Promotion Parties in connection with the Promotion. I also acknowledge that I am solely responsible for obtaining identification documents necessary for travel, and that Sponsor and Promotion Entities are not responsible if, for any reason, I am denied entry into the travel destination(s). I also understand that Sponsor will not replace any lost, mutilated, or stolen tickets, travel vouchers, or certificates. In further consideration of my being the Prize Winner's Guest and enjoyment of certain aspects of the Prize, I hereby grant to Sponsor and its designated agents and representatives the right, without limitation, to use my name, biographical information, photos, likenesses, videos, voice, and statements, worldwide in any medium in any future advertising, commercial, trade, or promotional material or press

6 releases connected with the Promotion, without further compensation or consultation, in any manner that Sponsor so determines, and I further agree that such use can be made without my inspection or approval of any copy used in connection with it. The provisions of this Affidavit & Release shall be governed by and constructed in accordance with the laws of the State of Michigan excluding its conflict of laws principles. I hereby irrevocably submit to the jurisdiction and venue of a court of competent jurisdiction located in Oakland County, Michigan. I warrant and represent that I have the full right and power to enter into this Agreement & Release, and that the terms of this document do not in any way conflict with any existing commitment on my part. I declare that I am over eighteen (18) years old and the age of majority in my jurisdiction of residence or that I have my parent or guardian s consent as indicated by his/her signature below. I have read this Agreement & Release, I understand its contents, and I intend to be legally bound hereby. I have received good and valuable consideration for this waiver and release. My Legal Name My Address My Phone Number(s) Cell: Home: Date of Birth (MM/DD/YYYY) Home Address (Street Address, City, State, ZIP) Signature Date: If the subject is a minor: I declare that I am the parent or guardian of the minor child whose name is set forth above and hereby confirm the signature of my minor child and consent to the rights and obligations set forth above. Parent/Guardian Signature of Minor Child: You are required to have a Notary Public verify identification and sign below. STATE OF COUNTY OF On this, the day of, 2016, before me a notary public, the affiant, personally appeared, known to me (or satisfactorily proven by presentation of photo

7 identification) to be the person whose name is subscribed to within this document, and acknowledged that he/she executed the same for the purposes stated therein. Sworn To Before Me This Day, 2016 Notary Signature My Commission Expires: