release form giveaway

Giveaway Release

Your name *

First

Last

Email *

Phone *

Age *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

(6 x 2) + (30 ÷ 3) = ? *

Do you want to include your website or social links?

Personal Bio

To be posted alongside your name on our social channels. Only include if you want.

What will you use the prize for?

Let us know what you may want to do or purchase with your prize.

Which Amazon portal do you use? *

example: .com, .ca, .co.uk, .de

1. I confirm that I have read, understand, have agreed to, and have complied with the Official Rules governing the Contest, which Contest was administered by Elegant Media Publishing Corporation. *

I agree

2. I acknowledge that the prize outlined in the Official Rules is subject to terms and conditions set out in the Official Rules. I have complied, and will continue to comply, with all such terms and conditions. *

I agree

3. I grant to Elegant Literature (the “Sponsor”) the irrevocable right to record, photograph or otherwise capture or document me, my likeness, my voice, or any statements made by me regarding the Contest or the prize, by any available means. I agree that any such captured material, together with my biographical information, and any information provided in this form, or the Entry Material (collectively, all such materials, the “Publicity Material”) may be used by the Sponsors or their licensees, successors, or assigns (collectively, the “Publicity Parties”) in any media, whether now known or later devised, worldwide and in perpetuity, for advertising or promotional purposes related to the Contest or any similar contest. *

I agree

4. I release and forever discharge the Sponsors, their respective parents, affiliates, and subsidiaries, any other companies associated with the Contest, and all of their respective directors, officers, employees, agents, representatives, licensees, successors and assigns, as well as any third party social media or social networking service or site related to the Contest, if any, (collectively, the “Releasees”), and agree to indemnify and hold harmless each of the Releasees, from and against any and all claims, damages or liability, including any costs or losses related to personal injury, death, damage to or loss or destruction of property, arising out of, or in any way related to (i) my participation in the Contest, (ii) the awarding, receipt, possession, use or misuse of the prize, in whole or in part, or any travel or activity related to the prize, (iii) the use of any Entry Material or Publicity Material in accordance with the rights granted in the Official Rules or this Release, or (iv) any breach of this Release, including any representations, warranties or covenants in this Release *

I agree

5. I understand that failure to return this executed Release as directed may result in the forfeiture of the prize. I confirm that I have read this Release, fully understand its contents, and am signing this Release voluntarily, with intent to bind myself. I agree that the terms of this Release shall be effective and binding upon my heirs, next of kin, executors, administrators, assigns and representatives. I confirm that it is my wish that this Release, as well as any other document relating to this Release, be drawn up only in English. *

I agree

Signature *