CVC Contest Form Contest Entrant and Declaration Release Form Please state the name of the Credit Valley Conservation Contest (the “Contest”) of which you are you are the selected entrant.(Required) Name(Required) First Last Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email(Required) Prize: The Prize, as described in the official contest rules & regulations. In order to qualify as a winner of the above prize, you must first correctly answer the skill-testing question: 5 x 18 =(Required)Consent(Required) I agree to the contest rules.I, the Selected Entrant named above, in consideration of being selected as the Selected Entrant, and in consideration of receiving the Prize as described in the official Contest Rules, HEREBY: 1. accept the Prize as described in the official Contest Rules, and declare that I have complied with all rules and regulations as stated on the official Contest Rules; 2. If the selected Entrant is under the age of 18, a parent/guardian will receive the prize on behalf of the minor. 3. confirm that I am a legal resident of Ontario, reside in the Credit River Watershed. meet the eligiblity criteria stated in the official Contest Rules and that I have reached the age of majority of 18, and that neither I nor any member of my immediate family (or persons with whom they or I are domiciled with) is an employee of Credit Valley Conservation Authority, their affiliates, advertising and promotional agencies. 4. agree to the use of my name, address, photograph, voice and/or video image in any publicity carried out by Credit Valley Conservation Authority and/or its advertising or promotional agencies without payment or compensation; 5. release and hold harmless Credit Valley Conservation Authority, its affiliates, agents, advertising and promotional agencies, their respective employees, officers and directors, in respect of any injuries, accidents, costs, liabilities, losses, damages and expenses of every kind and nature whatsoever arising from or relating in any manner to the holding of this Contest or my participation in the Prize. Signature of Selected Entrant:(Required)Date MM slash DD slash YYYY For the Selected Entrant to be awarded the Prize, this form must be duly signed and submitted by Draw Date deadline.CAPTCHAPhoneThis field is for validation purposes and should be left unchanged. Δ
