Q100 - Pick Your Plastic

SUBMIT YOUR PICK

Name:

Age:

Pick Your Plastic: (Up to 5)

1: Botox	2: Juvederm, dermal filler for wrinkles	3: Lipodissolve	4: Mesotherapy
5: Radiesse, dermal filler for deep wrinkle and fold	6: Consultation for anti-aging/hormone replacement therapy, weight management & 1st month supplies	7: IPL photo-rejuvenation with microdermabrasion	8: Day at the Spa package
9: Laser hair removal	10: Acne treatment	11: Skin tightening with age spot removal	12: Chemical peel
13: Tattoo removal	14: Smooth peel skin resurfacing treatment	15: Breast augmentation	16: Breast lift
17: Body contouring	18: Upper/lower lid blepharoplasty	19: Facial rejuvenation	20: Chin or cheek augmentation
21: Male breast hypertrophy reduction	22: Rhinoplasty	23: Birthmark removal	24: WILD CARD! What do you want?????

Why?:

What hour do you listen to Q100 most?:
Please make sure you're listening during the time you give us!

What number can we reach you during that time?:

This ASSUMPTION OF RISK AND LIABILITY RELEASE AGREEMENT ("Release") is executed on the date submitted to www.allthehitsq100.com , in agreement to  participate in the "Pick Your Plastic" (the "Contest"), in favor of Cumulus Media Partners LLC, radio station WWWQ-FM, and their parents, subsidiaries, affiliates, members, directors, shareholders, officers, employees and agents (collectively, "Cumulus"), whose address is 780 Johnson Ferry Rd., 5th Floor, Atlanta, GA 30342, sponsor of the Contest. 

      In consideration of being allowed to participate in the Contest, and for other good and valuable consideration, the receipt and sufficiency of which I hereby acknowledge, I hereby promise and agree as follows: 

I, by signing this Release, acknowledge that there are certain risks associated with my participation in the Contest, any of which could result in serious bodily injury or death.  I represent, warrant, covenant and agree that I am participating in the Contest entirely of my own choice and volition, and that it has not been requested, suggested or required in any way by Cumulus that I participate in the Contest.  I acknowledge and recognize that my participation in the Contest could involve potential danger to my person and property, and I knowingly and voluntarily intend to participate in the Contest after being apprised of such danger.  
I, on my own behalf and on behalf of my heirs and assigns, do hereby now and forever fully and finally release, remise, acquit and discharge Cumulus of and from any and all rights, claims, debts, damages, demands, actions, liabilities, responsibilities, causes of action, covenants, suits and judgments, of any kind or nature whatsoever, whether known or unknown, developed or undeveloped, anticipated or unanticipated, discoverable or undiscoverable, which I have or might have or might claim to have against Cumulus, arising out of or in any way related to or associated in any way with regard to my participation in the Contest, and any injury, damage or loss of any nature related to or arising out of or in connection therewith.  
I covenant and agree not to sue Cumulus upon any claim, demand, right of action, cause of action, lawsuit, damage, loss or expense of any nature whatsoever, in law or in equity, which I now have, have had, or may hereafter claim to have or have had, against Cumulus arising from or by reason of any matters, conduct, transactions, liabilities or obligations with respect to the Contest as to which any Cumulus entity might have any resultant or consequent liability to me. 
I understand and agree that this Release is not, and shall not be construed as, an admission by any Cumulus entity of any liability whatsoever.  This Release and each of its provisions shall not be offered or received in evidence in any action or proceeding as an admission or concession of liability of any nature on the part of any Cumulus entity.  I further understand  and agree that this Release contains the entire agreement between Cumulus and me relative to its subject matter, and no representations or agreements, oral or otherwise, between the parties not included herein shall be of any force or effect. 
The parties agree that the terms of this Release shall be binding upon and inure to the benefit of the parties and their respective heirs, successors and assigns.  Notwithstanding anything herein to the contrary, this Release shall be fully enforceable by either party in any action at law or in equity, and nothing contained herein shall preclude or be construed to preclude any action in law or in equity by either party against the other to enforce the provisions of this Release.  The parties further agree that, in the event of a dispute about the meaning, construction, or interpretation of this Release, no presumption shall apply to construe the language of this Release for or against any party to this Release.  This Release shall be governed by and enforced and interpreted in accordance with the law of the State of Georgia.  If any provision or part of a provision of this Release shall be determined to be void or unenforceable by a court of competent jurisdiction, the remainder of this Release shall remain valid and enforceable by any party.

I agree to the above terms

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