Affidavit of Eligibility and a Liability and Publicity release form


"I” or "Winner” say:

I give this Affidavit to The Horse BackStreet Choppers Magazine, Inc (the “Sponsor”) with the full understanding that this Affidavit signed by me, must be completed, signed and returned within two business days of the date that the contest ended as a condition to my being entitled to receive the Prize(s) in the Promotion.

I hereby state that I have complied fully with all of the official rules (the “Official Rules and Terms”) of the Promotion, and that I meet the eligibility requirements specified in the Official Rules & Terms and I agree to comply with all of the requirements of the Promotion as interpreted by Sponsors, and I am fully qualified to be awarded this/these Prize(s).

I understand that all taxes are the sole responsibility of the Winner.

I agree to and hereby release, discharge, indemnify and hold harmless, on behalf of my assigns, personal representatives and heirs, the Sponsor and Administrator, and its respective parent companies, subsidiaries, affiliates, production partners, advertising agencies, promotional suppliers, participating vendors or any other company involved in the design, production, execution or distribution of this Promotion (collectively, the “Released Entities”) from and against any and all liability, claims, damages, demands, causes of action, costs and expenses (including reasonable counsel fees) I may have now and in the future, no matter how caused, arising out of, or in connection with the Promotion, travel to, preparation for and participation in this Promotion, including without limitation, liability for personal injury, damage or loss, associated with said prize awarded or to be awarded or any breach or alleged breach by me of any affirmation, undertaking or obligation in this agreement. I further agree that in the event I bring a claim or lawsuit in violation of this agreement, I shall be liable for any attorneys’ fees and costs incurred by Released Entities in connection with such claim or lawsuit.

In addition, I agree to and hereby release on behalf of my assigns, personal representatives and heirs, the Released Entities from and against all liability with respect to in any way arising out of my tax liabilities and/or use of my name, likeness, voice or any other material I submit for the participation in the Promotion, including, but not limited to, any claim based on publicity rights, defamation, invasion of privacy, copyright infringement, trademark infringement or any other intellectual property related caused of action, or otherwise in connection with or related to the Promotion.

I understand that Sponsor will not obtain any liability, travel, automobile or other insurance on my behalf, and that I am fully responsible for obtaining my own insurance should I desire it (if applicable).

I accept the Prize at my own risk and take sole and absolute responsibility for any injuries incurred out of my participation in the Promotion or the use of the Prize(s), including, without limitation, the risk of personal injury and/or death, and WILL NOT HOLD SPONSOR, ADMINISTRATOR, OR ANY OTHER RELEASED ENTITY RESPONSIBLE.

I understand that the Sponsor is responsible only for prize delivery; not responsible for prize utility, quality or otherwise.

I also consent to the use of my name, voice, image, biographies and/ or likeness (individually, together or with others) by Sponsor or their assigns for advertising, publicity and trade purposes in any and all media worldwide in perpetuity without any compensation payable to me.

I understand that this Affidavit is intended to be as broad and inclusive as permitted by law, and I agree that if any portion of this Affidavit is invalid, the remainder will continue in full force and effect. Furthermore, I understand this Affidavit and swear that it is true.