THE HAMILTON SECURITIES GROUP, INC.

 

AFFIDAVIT OF ELIGIBILITY AND

PUBLIC RELATIONS & LIABILITY RELEASE

 

This Affidavit, when signed, notarized, and returned, will serve as a certification of eligibility and public relations and liability release for the person listed below, who has been notified that he or she is the winner of a Prize under the StreetEquityä Venture Challenge Contest (PLEASE PRINT):

 

 

Name of Winner:_________________________________________________________

 

Address:________________________________________________________________

 

 

Social Security Number: ______________________________ Date of Birth:_________

 

Home Telephone Number:_____________________________

 

Work Telephone Number:_____________________________

 

 

1. I certify that I am a legal resident of the United States who is at least eighteen (18) years old.

2. I certify that I have read and do understand and agree to comply with the 1997,1998 Official Rules of the StreetEquitytm Venture Challenge Contest (the "Contest").

3. I certify that I have submitted a Contest Entry based on my unpublished original work.

4. I assign all copyrights and moral rights arising under statute, common law, and all other rights derivative therefrom in my Contest Entry to The Hamilton Securities Group, Inc. ("Hamilton"). I further grant to Hamilton permission to publish, copy and disseminate all or part of my Contest Entry, the ideas and/or transactions described therein.

5. I hereby grant to Hamilton permission to utilize my name in any related advertising or promotional campaigns as Hamilton may deem appropriate from time to time, all without additional compensation to me.

6. I acknowledge and agree that, except for any Prize which I am awarded under the Contest, Hamilton is under no obligation to provide further compensation to me with respect to my Contest Entry, the ideas and/or transactions described therein. I hereby waive any and all rights I may have to further compensation from Hamilton and/or its subsidiaries and other affiliates with respect to my Contest Entry, the ideas and/or transactions described therein.

7. I acknowledge and agree that the ideas and/or transactions described in my Contest Entry may be used, commercially or otherwise, by Hamilton and/or its subsidiaries and other affiliates in any manner it or they may deem appropriate.

8. I hereby release Hamilton, Jordan Family Enterprises, Inc., and their respective employees, officers, directors, independent contractors, agents, representatives, affiliates, and subsidiaries from any harm, damage, liability, cost or expense whatsoever with respect to or in connection with the Contest.

9. I understand that my failure to return to Hamilton a signed and notarized copy of this Affidavit within 10 business days after being notified of winning a Prize under the Contest may result in my forfeiture of such Prize.

10. I accept sole responsibility as a winner of a Prize under the Contest. I understand that I am solely responsible for the reporting and payment of any applicable federal, state, local and other taxes imposed as a result of winning a Prize under the Contest.

THIS AFFIDAVIT MUST BE SIGNED, NOTARIZED AND RECEIVED BY THE HAMILTON SECURITIES GROUP, INC. WITHIN 10 BUSINESS DAYS AFTER PRIZE NOTIFICATION. YOU MAY FAX A NOTARIZED COPY TO STREETEQUITYtm VENTURE CHALLENGE CONTEST AT (202) 496-6777 AND MAIL THE ORIGINAL TO OUR OFFICES:

 

StreetEquitytm Venture Challenge Contest

c/o The Hamilton Securities Group, Inc.

7 Dupont Circle, NW

Washington, DC 20036

 

I have read and understood the above Affidavit of Eligibility and Public Relations & Liability Release.

 

 

Signature of Winner:______________________________ Date:______________

 

Subscribed and sworn to before me this day of , 1997/1998 at [City and State]

_______________________________ .

 

Notary:_________________________________ [My Commission Expires] Date:___________.