Your name *Your phone number *your email address *Name of person being nominated *Age of person being nominated *Phone number of nominee (leave blank if you are nominating yourself) *Address of person being nominated *Apartment, suite, etcCityState/ProvinceZIP / Postal CodeCountry Select countryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaAustraliaArubaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGuernseyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauNorth MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontserratMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSaint HelenaSaint Pierre & MiquelonSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUS Minor Outlying IslandsUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemen Arab Rep.Yemen DemocraticZambiaZimbabweHow will you, or the person you are nominating, use this grant money? Or, why is the grant so important? *How do you listen to WEMX? *Radio in my carExternal radio with an antenna (stereo, etc.)Mix of radio and streamingStreaming via WEMX website or appOther appDo you currently bank with a local community bank or a local credit union? If so, which one? *Contest rules *I agreeA complete copy of these Standard Contest Rules can be obtained at the offices of radio station insert call letters(the “Station”)owned and operated by Cumulus Media Inc. or one of its subsidiary companies, insert station address, during normal business hours Monday through Friday or by sending a self-addressed, stamped envelope to the above address. The Station will conduct all Contests, including on-air contests, email and online contests held on insert station website address, and contests conducted through the Station’s social networking accounts (e.g., Facebook, Twitter), substantially as described in these rules, and by participating each participant agrees as follows: 1. No purchase is necessary. Void where prohibited. All federal, state, and local regulations apply. 2. Unless otherwise specified, only legal U.S. residents who are 18 years of age or older with a valid Social Security number at the time of entry are eligible to participate in Station contests. Individuals age 13 to 17 may be eligible to participate in Station contests with the approval of a parent or legal guardian, provided that the parent or legal guardian is a legal U.S. resident at least 18 years of age with a valid Social Security number at the time of entry in the contest. 3. Unless otherwise specified, employees, agents and affiliates of Cumulus Media Inc. and its subsidiaries, contest sponsors, other radio, television and print advertising companies serving the Station’s metro area, and their immediate family members and household members are not eligible to participate or win Station contests. The term “immediate family members” includes spouses, parents, siblings, grandparents, children, grandchildren and cohabiting significant others. 4. An individual may win a Station contest only once per six-month period unless otherwise specifically stated. An individual may win other seasonal or one-time contests only once for the duration of the contest. The Station reserves the right to limit the number of times an individual may enter a contest or drawing. The Station reserves the right to require contestants to be present at drawings in order to win their prize. 5. Potential contest winners will be selected by and at the Station in its sole discretion. If it is determined by the Station that a candidate is not eligible to receive a prize, another candidate may be selected for eligibility consultation and this process will continue on until such time as an eligible candidate is found. In the unlikely event that no candidates are found to meet the specifications, then the prize will go un-awarded. In the event of a tie, the winner will be determined by and at the sole discretion of the Station. 6. Time Delay Between Over-the-Air Analog Signal and Other Signal Delivery: Due to the time delay that exists between the Station’s analog over-the-air signal and the Station’s online webcast, listeners who listen to the Station online may hear Contest information or a cue to call later than listeners listening to the Station’s analog over-the-air signal. As a result, the odds of an online listener winning this Contest may be diminished. 7. Unless otherwise stated, the odds of winning a Station contest depend on a number of factors, including but not limited to the number of eligible entries received and the number of listeners participating at any given time. 8. All State, Local, Federal and or other taxes, duties, tariffs, title fees, licensing fees, or other fees for prizes awarded become the sole responsibility of the winner. All those who win a prize or prizes valued $600 or more in a given calendar year will be issued an IRS Form 1099 to report their winnings. 9. All prizes are awarded “as is.” Prizes are nontransferable and cannot be exchanged, sold, or redeemed for cash or other prizes. No substitute prize will be awarded to a winner who declines to accept a prize. The Station shall not be responsible for a failure of participating sponsors to deliver the prizes or any part thereof. 10. All entrants and winners agree that the Station shall have no liability for any injury, misfortune, or damage to either persons or property incurred by entering, participating in, winning, or losing any contest and/or by the use or non-use of any prize received in connection with this contest. 11. All prizes must be claimed in person at the Station at the address identified above during regular business hours and within ten (10) business days of winning, excluding holidays. After such time, ownership of said prize reverts back to the Station to be disposed of at its discretion. The winner then loses all claims and rights to said prize. Proper identification must be presented by any winner to claim prize. As a condition to receiving the prize, any potential winner must complete and sign a Winner’s Affidavit and Release, releasing the Station from all liability in connection with winner’s participation in the contest and acceptance, use, or non-use of the prize. 12. All entry blanks, forms, devices, and materials gathered during the course of entry, as well as all information contained on or within, shall become the sole property of the Station to be used, disposed of or destroyed in its sole discretion. The Station is not responsible for any incorrect or inaccurate information submitted by contest participants or entered by websites users, and assumes no responsibility for any error, omission, interruption, deletion, defect, delay in operation or transmission, communications line failure, theft or destruction or unauthorized access to the Station’s website. 13. All entrants and winners agree to give the Station and its licensees, affiliates, successors, and assigns the irrevocable and unrestricted right to use, re-use, broadcast, or publish their name, city of residence, photo, video tape, film or any other likeness, including portraits and pictures, in whole or in part, as part of a composite, retouched or distorted in character or form, and voice, recorded or live, for any reason the Station deems necessary without compensation, unless prohibited by law. All entrants and winners release, discharge, and agree to hold the Station harmless from any and all claims they may have against the Station in connection with the foregoing. All entrants and winners further acknowledge that the Station and owns or will own exclusively any photographs of them used for such purposes, including the copyrights in them, regardless of the form in which they have been or may be produced and used, and all entrants and winners assign all such ownership rights to the Station. 14. By participating in a Station contest, each participant agrees to receive email communications from the Station regarding Station events and contests. Any participant that opts-out of these mailings will also remove themselves from the contest. By participating in the contest, where allowed by law, participants agree that the Station may disclose personal information obtained from participants in the contest to third parties and use such information for marketing and other purposes. 15. By participating in a Station contest, participants agree to be bound by the decisions of Station personnel. Participants who violate any rule, gain unfair advantage in participating in the Contest, or obtain winner status using fraudulent means will be disqualified. Unsportsmanlike, disruptive, annoying, harassing or threatening behavior is prohibited. The Station will interpret these rules and resolve any disputes, conflicting claims or ambiguities concerning the rules or the contest and all Station decisions concerning such disputes shall be final. If the conduct or outcome of a contest is affected by human error, any mechanical malfunctions or failures of any kind, intentional interference or any event beyond the control of the Station, the Station reserves the right to terminate the contest, or make such other decisions regarding the administration or outcome as the Station deems appropriate. All decisions will be made by the Station are final. The Station may waive any of these rules in its sole discretion. ANY ATTEMPT BY A CONTESTANT OR ANY OTHER INDIVIDUAL TO DELIBERATELY CIRCUMVENT, DISRUPT OR DAMAGE ORDINARY AND NORMAL OPERATION OF A STATION CONTEST, TELEPHONE SYSTEMS OR WEBSITES, OR UNDERMINE THE LEGITIMATE OPERATION OF A STATION CONTEST IS A VIOLATION OF CRIMINAL AND CIVIL LAWS AND SHOULD SUCH AN ATTEMPT BE MADE, STATION RESERVES THE RIGHT TO SEEK DAMAGES FROM ANY SUCH PARTICIPANT TO THE FULLEST EXTENT PERMITTED BY LAW. 16. By participating in this contest, each participant agrees to waive any and all claims for damages for death, personal injury, loss of property or property damage that he or she may sustain as a result of his or her participation in the contest and/or the use of any prize, and any damages or losses arising from the implementation or carrying out of the contest or any participant’s failure to win the contest or receive the prize, and to release Cumulus Media Inc., the Stations, and their parent companies, subsidiaries, affiliates, directors, officers, employees and agents from any and all liability arising out of or connected in any way with his or her participation in the contest, even though that liability may arise out of an intentional act, omission, negligence or carelessness on the part of the persons or entities mentioned above. 17. A winners list may be obtained five (5) days after the conclusion of any Station contest by sending a self-addressed stamped envelope to the Station at the address first written above.Enter!
