D.G. YUENGLING & SON, INC.

YUENGLING HERSHEY’S CHOCOLATE PORTER SWEEPSTAKES ELIGIBILITY,

WAIVER AND RELEASE

In consideration of my participation in the D.G. Yuengling & Son, Inc. (“Yuengling”)

YUENGLING HERSHEY’S CHOCOLATE PORTER SWEEPSTAKES sponsored by Yuengling,
the Giveaway Sponsor and the Prize Supplier (Sponsor) I ______________________ have executed this
Eligibility, Waiver and Release intending to be bound by the terms and conditions.

1. RELIANCE. I am submitting this Eligibility, Waiver and Release to the Sponsors with the
understanding that it will be relied upon to determine whether I am entitled to receive a Prize in
the Yuengling YUENGLING HERSHEY’S CHOCOLATE PORTER SWEEPSTAKES. I
acknowledge and represent that I am 21 years of age or older.

2. ELIGIBILITY. I affirm and state that I am eligible to win the YUENGLING HERSHEY’S
CHOCOLATE PORTER SWEEPSTAKES in compliance with the Official Rules and that
all information contained herein this Eligibility, Waiver and Release is correct.

3. PERSONAL INFORMATION. The following information is my personal information

and is true and correct.

a. Name: _______________________
b. Address: _______________________
c. City/State/Zip: _______________________
d. Telephone Number: _______________________
e. Cell Phone Number: _______________________
f. Email Address: _______________________
g. Date of Birth: _______________________
h. *Social Security Number: _______________________
i. Current Employer: _______________________

4. PUBLICITY RELEASE. I agree to the use by the Sponsors their designees of my name,
biographical information (city and state), picture, portrait, voice, quotes, comments, image,
and/or likeness for the purpose of advertising, trade or sweepstakes without further
compensation, notification or consideration in any and all media now known or hereafter
developed throughout the world, in perpetuity, unless prohibited by law.

5. PROHIBITED RELATIONSHIP. I represent to Yuengling that neither I, nor my family

members are a director, officer, employee, agent, shareholder, member, and/or principal of any
of the Sponsors.

6. OFFICIAL RULES. I have read and understand and agree to be bound by the Official Rules
in consideration of my participation in the Yuengling YUENGLING HERSHEY’S
CHOCOLATE PORTER SWEEPSTAKES.

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 7. COMPLIANCE. I represent that I have complied with all the rules and regulations of the
Giveaway and that I have perpetrated no fraud or deception in entering or in claiming my prize.

8. NO SUBSTITUTIONS. I understand that I am entitled to receive only the announced prize and
that prizes are nontransferable and no substitutions will be made except at the sole discretion of
the sponsor.

9. RETURN OF PRIZE. I agree to return to the Sponsors any prize which may be awarded
to me if any statement made by me in this Eligibility, Waiver & Release is false.

10. TAXES. I acknowledge and agree that I am responsible for any taxes and fees that may become
due because of my winning of any prize. If applicable, I acknowledge that I am also responsible
for any additional options or upgrades, licenses, insurance, title and registration fees.

11. LIABILITY RELEASE. In consideration of my participation in the YUENGLING

HERSHEY’S CHOCOLATE PORTER SWEEPSTAKES sponsored by the Sponsors, and
of their award to me of a Prize, I for myself, my heirs, executors and administrators, hereby
waive, release, discharge and agree to hold harmless the Sponsors and their respective officers,
directors, employees, agents, successors and assigns, and anyone authorized by them, from any
and all losses, damages, costs, expenses, rights, claims, demands and actions which I, my heirs,
executors or assigns may have arising from my participation in and/or my use of the prize
awarded to me in the Yuengling YUENGLING HERSHEY’S CHOCOLATE PORTER
SWEEPSTAKES including but not limited to personal injuries, death, disability, property
damages, and attorneys’ fees and expenses for litigation and settlement. I also agree to
indemnify and hold harmless the Sponsors and their respective officers, directors, employees,
agents, successors and assigns or anyone authorized by any of them from any and all losses,
damages, costs, expenses, rights, claims, demands and actions which any other party may have
against me arising out of my participation in and/or use of the prize awarded to me in said
promotion including but not limited to personal injuries, death, disability, property damages,
attorneys’ fees and expenses of litigation and settlement.

12. NO WARRANTY. I hereby agree that the Sponsors have neither made nor are in any manner
responsible or liable for any warranty, representation, or guarantee, expressed or implied, in fact
or law, relative to any prize, including but not limited to its quality, merchantability, fitness for
particular purpose, or mechanical condition and acknowledge that Sponsors have neither made
nor are in any manner responsible or liable for any warranty, representation or guarantee,
expressed or implied, in fact or in law, relative to the prize including, but not limited to, its
quality or availability.
*The IRS requires that prizes valuing over $600.00 be reported as income. A winner’s social security
number is required to award all prizes over this amount.

Winner
I attest that I have read and understand all the foregoing provisions of this Eligibility, Waiver & Release
and agree to be bound by all of them.
Date:
_______________________ _______________________
(Witness) (Signature)
Name: Name:

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 13. GUEST PERSONAL INFORMATION. The following information is my personal
information and is true and correct.

a. Name: _______________________
b. Address: _______________________
c. City/State/Zip: _______________________
d. Telephone Number: _______________________
e. Cell Phone Number: _______________________
f. Email Address: _______________________
g. Date of Birth: _______________________

Guest ____________________________________
I attest that I have read and understand all the foregoing provisions of this Eligibility, Waiver & Release
and agree to be bound by all of them.

Date:
_______________________ _______________________
(Witness) (Signature)
Name: Name: