WINNER ACKNOWLEDGEMENT FORM
READ CAREFULLY BEFORE SIGNING:
In consideration of being permitted to participate in the Valentine's Day Giveaway (“Sweepstakes”), I make the following representations and covenants:
1. I accept full responsibility for and will pay any and all applicable Federal, state and local income taxes, and any and all other fees and taxes arising out of my receipt of the prize.
2. I acknowledge that I have read the Official Rules of the Sweepstakes and represent and warrant that I have complied with all rules and agree with their terms and conditions.
3. I irrevocably grant to Audio-Technica U.S., Inc. (“Audio-Technica”), its successors and assigns, a non-exclusive license of unlimited duration (“License”) to use my product review, my name, picture, likeness and description in any and all present and future media, including but not limited to television, newspaper, radio, magazine, internet, electronic mail, photography, print, oral or written expression, or any other mode of media for the purpose of advertising, publicity, promotion, and trade, or as required by applicable state law.
4. I hereby release and forever discharge Audio-Technica, its officers, directors, employees, agents, successors and assigns, from any and all liability, actions, causes of actions and claims, including claims of patent, trademark or copyright infringement, arising from any injuries, damages, or losses now disclosed or known to exist as well as those unknown, unforeseen, unanticipated, and unsuspected, and all liability and consequences therefrom, resulting from the Sweepstakes, the awarding of the prize, use of the prize, use of the License, and any and all other consequences resulting from the Sweepstakes.
5. This Winner Acknowledgement Form is binding upon my heirs, executors, administrators and assigns.
I HAVE READ THIS WINNER ACKNOWLEDGEMENT FORM AND FULLY UNDERSTAND ITS TERMS. I UNDERSTAND THAT I HAVE GIVEN RIGHTS AND HAVE ASSUMED OBLIGATIONS BY SIGNING IT AND HAVE SIGNED IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT, ASSURANCE, OR GUARANTEE BEING MADE TO ME AND INTEND MY SIGNATURE TO BE A COMPLETE AND UNCONDITIONAL AGREEMENT TO THE TERMS OF THIS DOCUMENT.
Birth Date of Winner: ___/___/______