CONTEST: __________________________________________________
DESCRIPTION OF PRIZE:____________________________________
IN CONSIDERATIONS of qualifying and winning the above noted contest, I, ______________________ of: _____________________ hereby exonerate and save harmless BLACKBURN RADIO INC. (CFCO-AM-FM/CKSY-FM/CKUE-FM), SFAFT and DAI and anyone acting on their behalf from all claims, demands, injuries or causes of action which may now or hereafter arise as a result of any event or consequence arising from the said prize.
The prize offered herein is subject to the terms of the contest and shall remain in effect for a period of 6 months from this date after which time it will become null and void. The prize offered may not be transferred or assigned to any other person or persons without written consent or BLACKBURN RADIO INC. (CFCO-AM-FM/CKSY-FM/CKUE-FM), SFAFT and DAI reserves the right to withdraw this prize or provide a substitute prize for any reason at any time.
DATED AT _______________________this ____________day of _______________ in the year __________.
SIGNED, SEALED and DELIVERED
IN THE PRESENCE OF: ____________________________
Witness
_________________________
Contest Winner
__________________________
Contest Winner
______________________________________
Authorized for CFCO-AM-FM/CKSY-FM/CKUE-FM
BLACKBURN RADIO INC.