With this submission, I hereby claim all responsibility for my entry.  I also give permission to WXRV-92.5 The River to use my recording and likeness for promotional purposes.  WXRV owes nothing monetarily to any person entering this contest. I acknowledge that I have read and agree to all contest rules publishe on wxrv.com. I am a United States citizen or legal resident of the U.S. with a legal form of photo id.   I will not hold WXRV -FM liable for anything pertaining to this contest, including injury or death caused during the contest or by use of the prize. 

Name _____________________________________________

Address: __________________________________________

         __________________________________________

            __________________________________________

Phone:  _____________________________

Signed ___________________________    Date: ____________