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CONTEST WAIVE AND RELEASE FORM:
MY SIGNATURE BELOW INDICATES THAT I REALIZE
AND UNDERSTAND THE RULES AND ALL THE INFORMATION
ABOUT THE KBZE WEIGHT LOSS CHALLENGE.
I KNOW THAT I SHOULD SEE A PHYSICIAN BEFORE
STARTING ANY DIET OR EXERCISE PROGRAM.
I ASSUME ALL RISKS KNOWN AND UNKNOWN ASSOCIATED
WITH MY LOSING WEIGHT AND THE
PURSUIT OF THE PRIZE ASSOCIATED WITH
THIS PROMOTION.
HAVING READ THIS WAIVER AND KNOWING THESE FACTS,
I , FOR MYSELF AND ANYONE ENTITLED TO ACT ON
MY BEHALF, WAIVE AND RELEASE KBZE 105.9FM,
HUBCAST BROADCASTING, INC., THEIR SUCCESSORS
AND/OR ASSIGNS AND THE PROMOTION
SPONSORS FROM CLAIMS OR LIABILITIES OF ANY KIND
ARISING OUT OF MY PARTICIPATION IN THIS PROMOTION.
I GRANT PERMISSION TO ALL OF THE FORGOING
TO USE ANY PHOTOGRAPHS, MOTION PICTURES, RECORDINGS
OR ANY OTHER RECORD OF THIS PROMOTION FOR ANY LEGITIMATE
PURPOSE.
_______________________________________
SIGNATURE OF PARTICIPANT
__________________
DATE
_______________________________________
WITNESS
NAME____________________________________________
TELEPHONE#______________________________________
ADDRESS_________________________________________
__________________________________________________
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