AFFIDAVIT OF ELIGIBILITY AND LIABILITY / PUBLICITY RELEASE
I, __________________________________ hereby depose and say:
I am submitting this affidavit and release with the understanding that it will be relied upon to determine my
eligibility to receive a prize in the "AE LIVE YOUR LIFE CONTEST" (the "Promotion") sponsored by American
Eagle Outfitters, Inc. ("Sponsor").
1.
I hereby represent to Sponsor, West Coast Marketing, a division of the Susquehanna Hat Company, their
respective advertising and promotion agencies, parent corporations, subsidiaries, affiliates, agents, assigns,
and any other entity or person connected with the Promotion (collectively, the "Licensed Parties"), as well as
their respective directors, shareholders, officers and employees, that I have complied with, and will continue
to comply with, all of the rules and regulations of the Promotion and that I have perpetuated no fraud or
deception in entering the Promotion or in claiming any prize that may be awarded to me. I understand that I
will be disqualified from receiving any prize, which may be awarded to me, or will return immediately upon
demand by Sponsor any prize or the value of said prize that has been awarded to me, if any statement made
by me in this affidavit is false.
2.
I warrant and represent that I am a legal resident of the 50 United States, the District of Columbia or Canada
(except the Province of Quebec) and that I was fourteen (14) years of age or older as of the date of my entry.
3.
I also represent that neither I nor any member of my immediate family or anyone living in my household, or
the household of an immediate family member, is an employee of the Licensed Parties.
4.
I understand that the Licensed Parties will not be responsible for any costs I may incur in connection with the
Promotion or any prize I may be awarded. I further understand that I am responsible for any and all Federal,
state, local or other tax liabilities in connection with the acceptance of this prize.
5.
In consideration of my participation in the Promotion, I hereby release and discharge the Licensed Parties,
their respective employees, officers, directors, parent companies, shareholders, affiliates, subsidiaries,
advertising and promotion agencies and any other companies participating in the design, promotion,
administration or fulfillment of this Promotion (collectively, the "Releasees") from any and all claims,
demands, losses and liabilities of any nature whatsoever which I may now have or hereafter be entitled to
assert, including, but not limited to, any death, personal injury, loss of enjoyment or other harm or loss of
any nature whatsoever caused by, contributed to, or arising out of my participation in the Promotion or out of
any prize awarded to me in connection with the Promotion. I understand that the Releasees will not obtain
insurance on my behalf, and I am fully responsible for obtaining my own insurance.
6.
I hereby agree that the Licensed Parties shall have the right to use in perpetuity my name, likeness, voice,
photograph, biographical and prize information, and the Entry Materials (defined below), without notice to
me and without further compensation or obligation, in any and all media now or hereafter known throughout
the world, in any manner whatsoever, to advertise and promote Sponsors, their products and services, the
Promotion, and for any other purpose.
7.
I agree that any and all information or materials submitted by me with my entry in the Promotion (the "Entry
Materials") are now the sole property of the Licensed Parties and can be used, published, modified, adapted,
and otherwise exploited by the Licensed Parties in perpetuity in any manner whatsoever without further
notice or compensation to me and without attribution to me, in any and all media now or hereafter known
throughout the world. I represent and warrant that I am free to assign all the rights (including, but not
limited to moral rights and intellectual property) in and to the Entry Materials and such Entry Materials are
not subject to the rights of any third party. I acknowledge that the Entry Materials will not be returned to
me. I agree that no materials need be submitted to me for any approval and that the Releasees Parties shall
be without liability to me for any editing or alteration or for any distortion, illusionary or other effect
resulting from the publication or other use of my photograph and/or likeness and/or Entry Materials.
