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Prize Claim Form
     I understand that 98.3 WCCQ/NextMedia is not responsible for any lost, stolen, or damaged prizes which are sent to me by mail. I am aware that 98.3 WCCQ/NextMedia will not mail any prizes that are valued above $50.00, bulk prizes such as cd’s and DVD’s that have been won. 98.3 WCCQ/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 prize is valued over $500.00, contestants are not eligible to win for 60 days.

- Signing this waiver does not guarantee 98.3 WCCQ/Nextmedia will mail your prize and is subject to verification of prize won.

- 98.3 WCCQ/Nextmedia will hold prizes for a maximum of 30 days; prizes not claimed within 30 days will be forfeited and become property of 98.3 WCCQ/Nextmedia.
 
* First Name:  
* Last Name:  
* Street Address:  
* City:  
* State:  
* Zip Code:  
* Phone:  
* E-Mail:  
* Prize Won:  
 Yes
 No
* I agree to the above terms and conditions
  Questions marked with * are required