(Please print and complete the form to send with your photo entry via postal mail or drop off at a Lottery office.)
City, State, Zip:_____________________________________________________________________
Daytime Phone (8 a.m. - 5 p.m.): ( )______________ Alternate Phone: ( )________________
What's your pet's name and breed?: ________________________________________________________________________________
Description of photo: (In 100 words or less, explain what the photo illustrates.) ________________________________________________________________________________
Month/Year photo was taken:__________________________________________________________
By submitting this form, I hereby release the Missouri Lottery, its employees and agents, successor and assigns, from any and all claims which I may have arising out of any use of my photograph, name and likeness. I confirm that I am the owner of all rights, including copyright of the attached photo, and that I have read and agreed to the rules of the contest.
|Return to Details|