PRIZE ACCEPTANCE/RELEASE AND INDEMNIFICATION FORM
3D's(R) Malcolm in the Middle(TM) Sweepstakes
1. My social security number is: _______________________________
2. My date of birth is: _______________________________________
3. My telephone number is: __________________________________
4. My home address is: _____________________________________
_____________________________________
5. My email address is: _____________________________________
6. I am a legal resident of the State of: _________________________
7. I am above the legal age of majority in my state of residence or my parent or
legal guardian has co-signed below.
8. I represent that I (1) have fully complied with all of the Official Rules of
the Sweepstakes, and (2) have not committed any fraud or deception in
participating in the Sweepstakes or in accepting the Prize.
9. By accepting the prize, I (and my parent/legal guardian if I am a minor)
agree to release Frito-Lay, Inc. ("Sponsor"), FOX Broadcasting Company, 20th
Century FOX Television, Regency Entertainment, their respective parent,
subsidiary or affiliated companies, distributors, printing suppliers for this
promotion, advertising, fulfillment, judging or promotion agencies,
participating retailers, and all of their respective officers, directors,
employees, representatives and agents from any liability for, and to hold them
harmless against, any liability for injuries, losses or damages of any kind to
persons or property resulting in whole or in part, directly or indirectly, from
participation in the sweepstakes or acceptance, possession, misuse or use of
any prize.
Name [print full name]: _______________________________
Signature: _______________________________
Date: _______________________________
IF WINNER IS A MINOR IN HIS OR HER STATE OF RESIDENCE, WINNER'S PARENT OR LEGAL
GUARDIAN MUST COMPLETE THE INFORMATION BELOW:
I am the parent or legal guardian of the winner who has signed the foregoing
Release. I AGREE TO THE TERMS OF THE RELEASE AND CONSENT TO THE ACCEPTANCE OF
THE PRIZE ON THE WINNER'S BEHALF.
Parent/Guardian's Name [print full name]: _______________________________
Parent/Guardian's Signature: _______________________________
Date: _______________________________
Is it worth giving out a Social Security # for a free bag of Frito-Lay chips?
What do you guys think?