GOLD STAR CHILI FLAVOR FANATICS VIDEO CONTEST

PARTICIPANT RELEASE

Return to:  "Flavor Fanatic Video Contest"

Gold Star Chili, Inc.

650 Lunken Park Drive

Cincinnati, OH  45226

FAX – 513-624-4415           email:  info@goldstarchili.com

I,                                                                      , declare that I am over eighteen (18) years of age and that I appear in or contributed to (or that my minor childe appears in or contributed to) the video entry submitted in the Gold Star Chili "Flavor Fanatics Video Contest".  I hereby irrevocably consent to the use of my likeness, including my performance, voice and image in any form, as incorporated in my Video Entry by Gold Star Chili, Inc. and its affiliates, successors or licensees and others acting on its behalf for the purpose of advertising and promotion in any media.

I agree Sponsor shall own all right, title and interest to the Video Entry and that it may edit, modify and distribute the Video Entry without limitation, without compensation and without further permission or notification to me.  I hereby waive any inspection or approval of use.  I also waive and release Sponsor from any claims based upon invasion of privacy, right of publicity, or faulty mechanical reproduction.

No promise or representation of any kind have been made to me.  This Release has been fully reviewed by the undersigned and is entered into on the date set forth below.

PARENT/LEGAL GUARDIAN SIGNATURE NEEDED FOR PARTICIPANTS UNDER 18

Participant’s Name (First, Last)                                                   Age

Email Address

Parent/Guardian Name if applicable

Street Address, City, State, Zip

Participant or Parent Signature                                                   Daytime Phone Number

Date

CONTEST RULES