By submitting this Reimbursement Request Form, I hereby confirm the following:
- I am the primary member (not a joint account holder), and meet all eligible requirements set forth in the Members First - Empowering Teacher to Thrive Giveaway Terms and Conditions, a copy of which is available at MembersFirstfl.org ("Official Terms and Conditions").
- I acknowledge that I have read the Official Terms and Conditions and understand them fully. I represent and warrant that I am in full compliance with the terms and conditions and agree to comply with and abide by those rules that require future compliance.
- I agree to pay and all federal, state and local taxes (including without limitation, income, use or sales taxes or government charges) imposed on cash awarded to me in connection with this giveaway, and I hereby release Members First Credit Union of FL and shall indemnify and hold Members First Credit Union of FL harmless from and against any liability therefore.
- I agree to give Members First Credit Union of FL permission to reproduce, publish and/or broadcast my name, characters, voice, likeness, picture, statements and any biographical information in any form, without restriction or further notice. Members First Credit Union of FL may utilize this information for promotional purposes, advertising and other promotional tools in perpetuity without compensation of any kind. I understand that I will not have any ownership of intellectual property Members First Credit Union of FL creates using this information.
- I understand that the prize may be revoked if Members First Credit Union of FL learns that I disparaged Members First Credit Union during or after the Giveaway period. I am aware that Members First Credit Union of FL retains the right to take legal action against me if I commit libel or slander against Members First Credit Union of FL.
- I agree to indemnify and forever release Facebook, Members First Credit Union of FL, their agents, employees, corporate affiliates, advertising, public relations, and promotional agencies, its subsidiaries and assigns, and the officers, directors, employees and agents of each (the "Released Parties") from any and all liability for any damages, costs, injuries, accidents, misfortunes, or causes of action in any way resulting from my participation in the giveaway and/or acceptance or use of the reimbursement. I acknowledge that the Giveaway was in all respects conducted fairly and properly and I waive and release any rights I may have to claim to the contrary, and any other claims or causes of action of any nature against Members First Credit Union of FL which arise directly or indirectly out of the Giveaway.
- All my representations and other information contained in this document are true. The name given below is my legal name. I understand that if I fail to provide information requested herein, or if I make a false representation (including any false representation that I am at least the agent of majority in my state of residence and am a legal resident of the United States) Members First Credit Union of FL may require me to forfeit all of the Reimbursement credited to me and indemnify Members First Credit Union of FL for any losses or damages.
- I warrant and represent that I have the full right and power to sign this Reimbursement Request Form, and that the terms of this document do not in any way conflict with any existing commitment on my part.
- It is understood and agreed that this is a complete RELEASE and DISCHARGE of all claims and rights against the Released Parties, and that no action will be taken by me or on my behalf with respect to any such rights; it being understood that this release shall be binding upon my parents, guardian, heirs, executors, and administrators.
THIS IS A LIABILITY RELEASE. PLEASE READ CAREFULLY BEFORE SIGNING.
