WWE and Wheatley Vodka Event Registration form

WWE Superstar Maxxine Dupri will be on site at Virginia ABC Store 294 for a bottle signing on Sunday, June 14th from 11am-1pm. Please fill out the below registration form if you intend to participate. The store is located at:
3501B S Jefferson Street
Falls Church, VA 22041

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* 1. Name:

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* 3. Phone (optional):

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* 4. I would like to OPT-OUT of receiving communications from Virginia ABC

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* 5. I, the abovesigned, do hereby release all rights or claims in connection with the photo(s)/video(s) in which I appear, for use by the Virginia Alcoholic Beverage Control Authority (ABC). I understand that my name, likeness, voice and photo(s)/video(s) may be used for any lawful and commercial purpose for ABC including, but not limited to, publicity, illustration, advertising, education and web content, and agree to its usage.
I waive any right to inspect or approve the finished copy. I agree that the photo(s)/video(s) may be broadcast and distributed without limitation through any means, and I shall not receive any compensation for my participation. I further release ABC, its employees and agents from all liability which may arise from any or all claims by me or any third party in connection with my participation in the photo(s)/video(s). All photos and videos shall constitute the sole property of Virginia ABC. I declare that I am of legal age and have every right to contract in my own name in the above regard.

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