C100 & Virgin Radio Winner Release Form
I (Name listed in the form below), residing at the address indicated in the form below, declare that:
1. I meet all eligibility requirements and acknowledge I have read, understood and complied with the attached contest rules or thestation’s general contest rules as applicable (the “Rules”), notably in connection with my participation in the Contest and anyacceptance and use of the prize.
2.I have reached the age of majority in my place of residence. (If not, the DECLARATION OF THE PARENT OR LEGALGUARDIAN TO A MINOR must be filled out, for contests open to minors.)
3.I am not an employee of Bell Media Inc., of its agents, parent, affiliated or related companies, subsidiaries, divisions, prizesponsors, promotional and advertising agencies or of any other entity involved in the development, production, administration, orfulfilment of the applicable Contest (“Contest Parties”), nor am I such employee’s parent, sibling, child or domiciled with suchemployee.
4. I am eligible to win the prize offered to me if I can correctly answer the mathematical question in the form below.
5.If I correctly answer the above mathematical question, I accept the prize as awarded in accordance with the conditions inherent to its use and the Rules.
6.I hereby authorize Bell Media Inc., and any Contest Sponsor where applicable, to broadcast, publish, disseminate and otherwiseuse my name, city/town/village and province/territory of residence, photograph, likeness, sobriquet and voice, in connection withany promotion and/or publicity, and/or for general news, entertainment and/or information purposes at no additional compensation to me, beyond the awarding of or participation in the prize.
I declare that I have carefully read this release, understand its content, and consent to it of my own free will. This release also binds my heirs and successors. IN WITNESS WHEREOF, I have signed at the location specified in the form below.