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RAYSAC After Prom Grand Finale 2015
Participation Form for Qualifiers
Congratulations on being selected as a Qualifier for the After Prom Grand Finale (APGF)! We
want to thank you for choosing to participate in your school’s After Prom Party and for staying
alcohol, tobacco, and drug free. In order to participate in the After Prom Grand Finale, you are
required to review the following guidelines, sign below, and return this form during
registration at the After Prom Grand Finale Event.
1) In order to participate, you must attend the RAYSAC APGF Event on May 31, 2015.
The event will take place at the Tanglewood Mall (4420 Electric Rd, NW Roanoke, VA
24018). The drawing for the Grand Prize Car is subject to all applicable federal, state,
and local laws and regulations. Void where prohibited by law or restricted. NO
PURCHASE NECESSARY TO REGISTER OR WIN.
2) Registration for the event for Qualifiers will begin at 1:00 p.m. Registration for Qualifiers
will end promptly at 1:30 p.m. If you have not registered by this time, you will not be
allowed to participate in the After Prom Grand Finale Event.
3) If you are not present and registered by 1:30 p.m. on May 31, 2015, an Alternate will
take your place. Any prizes the Alternate may win will be his/hers to keep, including but
not limited to, the Grand Prize Car and Second Place IPad. You will not be entitled to
any portion of the prize(s) won by the Alternate.
4) If you are not planning on attending the After Prom Grand Finale Event, you must inform
your designated school representative so that an Alternate can be scheduled to take
your place.
5) At the APGF Event, one student from each school is guaranteed to win a $100 gift
certificate door prize. This prize will be given to one student from your school through a
random drawing process.
6) A 2015 Nissan Note will be the Grand Prize Car. The winner of the Grand Prize Car will
be selected at random from the registered Qualifiers and Alternates (if any) at the end of
the Event. The Winner must be present during the entire Event in order to remain
eligible to win the Grand Prize Car. The Winner will not have any choice of vehicle
color, interior color or upholstery, trim packages, or any other feature. Please note that
if you should win the Grand Prize Car:
a. It CANNOT BE TRADED FOR MONEY OR ANOTHER VEHICLE.
b. First Team Auto Mall (“First Team”) reserves the right, in its sole discretion, to
substitute the Grand Prize Car with a vehicle of equal or greater value. In the
event that First team exercises its right pursuant to this subsection (b), any and
c.
d.
e.
f.
g.
h.
all references to the Grand Prize Car will be deemed to refer to the substituted
vehicle.
All taxes, registration, titling and fees are the responsibility of the Winner of the
Grand Prize Car. Such costs are estimated to be between $600 - $700. In the
event that a person other than the Winner takes title to the Grand Prize Car
pursuant to subsection (d) or (e) below, that person shall be responsible for the
above noted costs. Payments of all federal, state and local taxes are solely the
responsibility of the Winner. The Winner (or substitute per subsections (d) or (e)
below) will be required to complete and submit an IRS Form W-9 or the
equivalent, including the Winner’s full Social Security Number, for receipt of the
Grand Prize Car. Failure to submit a complete W-9 or equivalent will result in
disqualification and forfeiture of the Grand Prize Car.
The Winner must have a valid U.S. driver’s license to take title to the Grand Prize
Car. If the Winner does not have a valid U.S. driver’s license and is 18 or older,
the Winner may designate a family member or member of his/her household to
take title to the Grand Prize Car. If the Winner does not have a valid U.S. driver’s
license and is below the age of 18, a parent or legal guardian of the Winner who
has a valid U.S. driver’s license and is approved by First Team may take title to
the Grand Prize Car. Such approval will not be unreasonably withheld.
The foregoing notwithstanding, if the Winner does have a valid U.S. driver’s
license and is 18 or older, the Winner may choose to assign his/her interest
in the Grand Prize Car to a member of the Winner’s family or household.
Such assignment will be subject to the approval of First Team, which,
approval will not be unreasonably withheld.
The Winner (or substitute per subsections (d) or (e) above) must provide
evidence of automobile insurance or proof of payment of any Uninsured Motor
Vehicle fee as may be required by the jurisdiction in which the Winner or
substitute is licensed to drive without automobile insurance. The Winner (or
substitute per subsections (d) and (e) above) is solely responsible for insuring the
Grand Prize Car.
Employees of Roanoke Area Youth Substance Abuse Coalition or First Team
(collectively, the “Sponsors”) and any parent, subsidiary or affiliated entity of the
Sponsors, or the members of any such employees’ immediate families or
households, are ineligible to participate or win the Grand Prize Car. Immediate
family members shall include spouses, parents, step-parents, children, stepchildren, siblings, and step-siblings, as well as their respective spouses.
Household members shall include any person who shares the same residence
with an employee for at least three months during the twelve months preceding
the Event.
The Winner will need to make arrangements to pick up the Grand Prize Car at
First Team Auto Mall within ten (10) days of the Event. First Team Auto Mall will
review all warranty information, paperwork, and details for the Grand Prize Car
with the Winner at the prearranged time.
7) By attending the After Prom Grand Finale you may be photographed. Any photographs
taken during the event may be used for promotional purposes. Participating in the Event
and acceptance of the prize constitutes Winner’s and guest’s (where applicable)
permission for the Sponsors or their agents to photograph, film and record the Winner
and their guest, and to use his/her name, adders (city and state), likeness, photograph,
voice, biographical information, and/or any statements made by him/her regarding the
Event or the Sponsors for purposes of trade, publicity or promotion without additional
financial or other compensation, and, the Sponsors may, where legal, require Winner
(and guest) to sign a publicity release confirming such consent prior to acceptance of
any awarded prize.
8) Sponsors reserve the right in their sole discretion, to substitute any prize (or portion
thereof) other than the Grand Prize Car with one of equal or greater value. Winners are
responsible for all applicable federal, state and local taxes, if any, as well as any other
costs and expenses associated with prize acceptance and use of the prize. Any
unclaimed prizes will not be awarded.
9) Sponsors reserve the right to cancel or modify the awarding of prizes, including the
Grand Prize Car, if fraud or technical failures compromise the integrity of the prize
drawing as determined by the Sponsors in their sole discretion.
10) Winner by acceptance of the prize, agrees to release, indemnify and hold harmless the
Sponsors, and each of their employees, representatives, owners, and advertisers, from
any and all liability, loss, damage, costs or claims related to any allegation regarding the
award of, the receipt of, or the use of their awarded prize.
If you have any questions, contact your school representative listed on the next page or
contact Becky Parr with RAYSAC at bparr@brbh.org – (540) 982-1427 ext 122.
School Representative Name: ___________________________________________________
Contact Phone Number ________________________________________________________
(this is the contact person from the school’s After Prom Committee you will contact with questions)
-----------------------------------------------------------------------------------------------------------------------------By signing this form you accept the responsibility of having read and agreed to adhere
to the above guidelines.
Qualifiers Name: _____________________________________________________________
School: _____________________________________________________________________
Qualifiers Signature: _________________________________ Date: __________________