3 Check appropriate box for federal tax classification of the person whose name is entered on
line 1. Check only one of the following seven boxes.
Note: Check the appropriate box in the line above for the tax classification of the single-member
owner. Do not check
LLC if the LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC
another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single-member LLC
is disregarded from the owner should check the appropriate box for the tax classification of its owner
4 Exemptions (codes apply only to
certain entities, not individuals; see
instructions on page 3):
(Applies to accounts maintained outside the U.S.)
Part I Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid
backup withholding. For individuals, this is generally your social security number (SSN). However, for a
resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other
entities, it is your employer identification number (EIN). If you do not have a number, see How to get a
Note: If the account is in more than one name, see the instructions for line 1. Also see What Name
and Number To Give the Requester for guidelines on whose number to enter.
Part II Certification
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be
issued to me); and
2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been
notified by the Internal Revenue
Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends,
or (c) the IRS has notified me that I am
no longer subject to backup withholding; and
3. I am a U.S. citizen or other U.S. person (defined below); and
4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
Certification instructions. You must cross out item 2 above if you have been notified by the IRS
that you are
currently subject to backup withholding because
you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does
not apply. For mortgage interest paid,
acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement
arrangement (IRA), and generally, payments
other than interest and dividends, you are not required to sign the certification, but you must provide your correct
TIN. See the instructions for Part II, later.
PARTICIPATION - RELEASE OF LIABILITY - PUBLICITY RELEASEREAD BEFORE SIGNING
Release of Liability
Participation in Anglers Insight Marketing, LLC™ (hereafter AIM) events is voluntary. I agree,acknowledge, and appreciate that:
- The risk of injury, disability, death, loss or damage to my person or property from th eactivities involved in these events is signif icant. While AIM has prepared rules, requir edequipment and personal discipline to reduce these risks, the inherent risks cannot beeliminated.
- I have had the opportunity to seek legal counsel with respect to the effects of this Release.
- I KNOWINGLY AND FREELY ASSUME ALL RISKS REFERRED TO ABOVE, BOTHKNOWN AND UNKNOWN, EVEN IF ARISING FROM THE NEGLIGENCE OF ANGLERSINSIG HT MARKETING, LLC™,ITS OFFICERS, OFFICIALS, DIRECTORS,SHAREHOLDERS, AGENTS, AND/OR EMPLOYEES, OTHER PARTICIPANTS,SPONSORING AGENCIES, SPONSORS, ADVERTISERS, OWNERS AND LESSORS OFPREMISES AND PROPERTY USED TO CONDUCT THE EVENT OR OTHERS(“RELEASEES”.) I ASSUME FULL RESPONSIBILITY FOR ALL RISKS ARISING FROM MYPARTICIPATION.
- I willingly agree to comply with the rules, terms and conditions that govern AIM events. I alsoagree to bring any hazards to the attention event officials.
- I. FOR MYSELF AND ON BEHALF OF MY HEIRS, ASSIGNS, PERSONALREPRESENTATIVES AND NEXT OF KIN, HEREBY RELEASE, INDEMNIFY, AND HOLDHARMLESS RELEASEES, WITH REPSECT TO ANY AND AL INJURY, DISABILITY,DEATH, OR LOSS OR DAMAGE TO PERSON OR PROPERTY, WHICH I SUFFER ORWHICH I AM FOUND TO HAVE CAUSED IN WHOLE OR IN PART BY MY NEGLIGENCEOR INTENTIONAL MISCONDUCT, WHETHER ARISING FROM THE NEGLIGENCE OFTHE RELEASEES, OR OTHERWISE, TO THE FULLEST EXTENT PERMITTED BY LAW. IHAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENTAND THE AIM RULES. I FULLY UNDERSTAND THE TERMS AND UNDERSTAND THAT IHAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING THIS RELEASE, AND SIGN ITFREELY AND VOLUNTARILY.
In consideration of my voluntary participation in the activities and events conducted by Anglers InsightMarketing, LLC™ (AIM) I hereby grant to AIM, its assignees and sponsors the unconditional right to usemy name, voice, photographic likeness, bio graphical information, comments, and instructions in anymediu m whatsoever, including but not limited to video/audio productions, merchandis ing, promotions,advertising, articles, and/or press releases in connection with AIM events and activities. I understand thatI will not be entit led to receive any royalties or other compensation for such use, or place any restrictionson such use. The Participant signifies by his/her signature below that he or she has read andunderstands the foregoing provisions. The Participant further certifies that his/her identity is correct.
I signify by my signature below that I have read and understand the AIM Rules, Release ofLiabili ty, and Publicity Release. I further certify that the boat being used in this competition has acurrent watercraft liabili ty policy in place, at a minimum of $100,000 (per occurrence) in the eventof an accident. I also agree to abide by any Local, State or Federal regulations.
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