KiSS 91.7 Prize Winner Release Form

Skill Testing Question: 20 x 6 - 60 =*

PRIOR TO CLAIMING ANY PRIZES, ALL LISTENERS MUST FIRST CORRECTLY ANSWER, UNAIDED, A SKILL TESTING MATHEMATICAL QUESTION

Name of Contest / Prize Won*

The prize you are claiming must match our records.

Date You Won Contest*

Your Legal First & Last Name*

First Last

Mailing Address*

Street Address Address Line 2 City Province Postal Code

Email*

Daytime Phone Number*

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 Rogers Communications Inc. or one of its subsidiaries or affiliates (“Rogers”).

2. I acknowledge that the prize described in brief above, and as more particularly 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 confirm that I will not resell or attempt to resell the prize, in whole or in part. . In the event that a prize consists of tickets to an event that has been cancelled or postponed, no substitution will be offered.

3. I represent and warrant that my Contest entry, including any material comprising my entry (e.g. name, user name, profile picture, etc., as applicable) and any material submitted with my entry (e.g. photograph, video, written submission, or other form of submission, as applicable) (all such material, collectively, the “Entry Material”) is original to me, and that I have all necessary rights in and to the Entry Material to have participated in the Contest and to enter into this Release.

4. I grant to Rogers and to any co-sponsors of the Contest (together with Rogers, the “Sponsors”) 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, such as name or place of residence, 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 understand and agree that any such use of the Publicity Material may include the reproduction, modification, adaptation, translation or creation of derivative works from the Entry Material. I acknowledge that the Publicity Parties shall not be required to compensate me, notify me, or request any further permission in connection with their use of any Publicity Material, unless otherwise prohibited by law. I waive any rights that I may have or that may otherwise exist in connection with any use of the Publicity Material by any of the Publicity Parties, including any moral rights in any such Publicity Material.

5. 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

6. 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. Je confirme ma volonté que cette Renonciation, de même que tout document qui y est relié, soient rédigés uniquement en anglais.

I am of Legal Age in the province of Alberta and live in the Edmonton area.

Today's Date*

NOTE: Once you hit "Submit", you will be redirected to the confirmation message at the top of the page that your form has been submitted. You will not receive an automatic email confirmation.

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