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102.3 XLC Prize Release Agreement

I agree to indemnify and hold 102.3 WXLC-FM/ALPHA MEDIA LLC harmless from any and all claims, suits and action which may arise out of, or any harms, liabilities or damages I may incur, as a result of my having won the aforementioned prize.

This includes hoverboards and hoverboard-type items. WXLC-FM/ALPHA MEDIA LLC is not responsible for any injuries sustained from the board.

I understand that WXLC-FM/ALPHA MEDIA LLC is not responsible for any lost, stolen, or damaged prizes which are sent to me by mail. I am aware that WXLC-FM/ALPHA MEDIA LLC will not mail any prizes that are valued above $150.00 or bulk prizes that have been won that cannot fit in a standard sized envelope. WXLC-FM/ALPHA MEDIA LLC will not be required to replace any prizes that have been lost, stolen, damaged, arrive late or compensate the winner for said items.

I understand that I will be issued an Internal Revenue Form #1099 to report prizes as earned income in the year in which it was won for any cumulative prize value of $600 or more within the calendar year.

In conjunction with the receipt of this prize, I hereby grant WXLC-FM/ALPHA MEDIA LLC permission to use my name and likeness in conjunction with reasonable promotion by the station of my participation in its promotion.

I hereby attest that I am not an employee of WXLC-FM/ALPHA MEDIA LLC or its agencies, nor is any member of my immediate family. Prizes will arrive within 5-7 business days from form submission.

 

102.3 XLC Prize Release Agreement

  • Drop files here or
    Accepted file types: jpg, gif, png, pdf.
    Please attach a clear photo or scanned copy of your state ID/driver's license. If you have issues, please e-mail to Janelle@AlphaMediaUSA.com.
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