Star 96.7 Prize Claim Form
 I understand that Star 96.7/NextMedia is not responsible for any lost, stolen, or damaged prizes which are sent to me by mail. I am aware that Star96.7/NextMedia will not mail any prizes that are valued above $50.00, bulk prizes such as CDs and DVDs that have been won. Star96.7/NextMedia will not be required to replace any prizes that have been lost, stolen, damaged, arrive late or compensate the listener for said items.


- Contestants are not eligible to win multiple prizes within 30 days and if the prize is valued over $500.00, contestants are not eligible to win for 60 days.


- Completing and submitting this waiver does not guarantee you will receive your prize automatically. It is subject to verification of prize won by the promotions department of Star96.7/Nextmedia.


- Star96.7/Nextmedia will hold prizes for a maximum of 30 days; prizes not claimed within 30 days will be forfeited and become property of Star96.7/Nextmedia.



- A complete set of rules can be viewed here.
 
* First Name  
* Last Name  
* Street Address  
* City  
* State  
* Zip Code  
* Telephone Number  
* E-Mail Address  
* Prize You Won on Star 96.7  
 Yes
 No
* I agree to the above terms and conditions
  Questions marked with * are required

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