Pay it Forward Nomination Form

Nominate a deserving volunteer to WIN $500!


Contest: Pay it Forward - $500 for each selected volunteer!

Station: Sinclair Communications, LLC dba KSAS

Station Address: KSAS, 316 N. West St. Wichita, KS 67203

Contest Area: Kansas counties: Sedgwick, Kingman, Reno, Harper, Sumner, Cowley, Butler, Harvey and McPherson

Sponsor(s): DeVaughn James Injury Lawyers

Prize Provider(s): DeVaughn James Injury Lawyers

Age of Eligibility: Sixteen (16).

Contest Period: January 2, 2018 to December 31, 2018

Entries Due: 12:00 pm CT on each Friday during the Contest Period.

Entry is limited to one (1) entry per IP address; however, a nominee may be nominated by multiple entrants. Remaining valid entries will carry over to the next Winner Determination Date.

Nomination Topic:

Nominate a deserving individual or family who “Pays it Forward” in the community and briefly describe the nominee’s story on how they “Pay It Forward” and why they should receive the prize. Nominees may be one of the following:

1. An individual, age 16 or older, who resides in the Contest Area;

2. A non-profit/charitable organization formed under Kansas state or federal laws that serves the Contest Area or

3. A family that resides within the Contest Area. Families are defined as a group of people made up of spouses, children, parents, aunts, uncles, cousins and/or grandparents who reside in the same household.

Entrants cannot nominate themselves. An entrant may nominate an individual member of his or her family. An entrant may not nominate his or her own family group/unit.

Judging Criteria: Need (40%), Impact (40%) and Newsworthiness (20%)

Total Number of Winners: Fifty-two (52)

Winner Determination Dates: Each Friday during the Contest Period.

Prizes and Values:

Each winner will be featured in a “Pay It Forward” segment during Station’s news program and will receive one (1) five hundred dollar ($500) cash prize. If a winning nominee is a family, a maximum of one (1) cash prize will be awarded to the adult family member listed as the designee in the nomination. If a wining nominee is an organization, the prize will be received by aTotal approximate value of prize is $500.00. Due to its nature, a value for the on-air feature cannot be determined.

Station’s Website:

Station’s Privacy Policy:

Station’s Website Terms and Conditions:

NO PURCHASE NECESSARY. This contest is subject to all applicable laws and regulations and is void where prohibited.

All capitalized terms shall have the meanings set forth above.

How to Enter

1. To enter, log on to the Station’s Website and click on the Contest section to access the Contest entry page. Complete the online entry form with:

a. Your name, address, phone number and birth date;

b. Name of Nominee (If Nominee is a family unit, list a designated adult member of the family who would receive the prize on behalf of the family if chosen as a winner);

c. Address of Nominee;

d. Describe in 200 words or less why the Nominee submitted for the Nomination Topic should win

and click submit. By entering, entrants agree that the nominee, not the entrant, is eligible to win the prize. No mechanically reproduced or completed entries will be accepted.

Judging of Entries/How to Win

1. Each entry will be judged and scored by a panel of judges comprised of Station personnel based on the Judging Criteria for the Nomination Topic.

2. On each Winner Determination Date, the judges will determine the Total Number of Winners with the highest score based on the criteria set forth above. Remaining valid entries will carry over to the next weekly drawing.

3. As a condition of winning, Winner must sign an appearance release and agree to be featured on-air by the Station; failure to do so will result in disqualification, and if time permits, an alternate winner may be selected. Whether or not the feature actually airs as well as the date, time, nature and extent of the feature remains at the sole and absolute discretion of the Station.

4. In the event an insufficient number of valid entries are received for judging, Station reserves the right to cancel the contest or reduce the Total Number of Winners and not select a weekly winner.


1. To be eligible to participate in the Contest, entrants must be U.S. residents who are at least the Age of Eligibility, and reside in the Contest Area. Nominees must be U.S. residents who are at least the Age of Eligibility, reside in the Contest Area and meet the criteria of the Nomination Topic.

2. Employees of Sinclair Broadcast Group, Inc., Sinclair Television Group, Inc., Station (collectively, the “Company”), Sponsor(s), Prize Provider(s), contest software providers, social media platforms, each of their affiliated companies, advertising and promotion agencies, any and all local television broadcast and cable stations, local radio and other media companies, and the immediate family members of each are ineligible. The term “immediate family” includes spouses, domestic partners, grandparents, parents, siblings, children, grandchildren, and any other relatives who reside in the same household with employee. Only one winner per household.

Contest Terms and Conditions

1. Station is not responsible for lost, late, garbled, or misdirected entries, printing errors, server unavailability, computer or any other electronic malfunction. All entries received that are duplicate, mutilated, tampered with, incorrect, illegible, or from ineligible entrants will be void. All entries become the property of the Company and will not be acknowledged or returned.

2. Station cannot be held liable for any lost or stolen entries, prizes or contest information. Station is not responsible for any technological malfunction, or human error relating to the Contest.

3. Prizes are provided “as is” without any express or implied warranty of any kind including warranties of merchantability, non-infringement or intellectual property, or fitness for any particular purpose. Prizes are subject to the Sponsor(s) and/or Prize Provider(s) standard terms and conditions, and expiration dates. For any ticket related prize, Station, Sponsor(s) and Prize Provider(s) are not responsible if any event or performance is cancelled or postponed.

4. Each winner will be notified by email or phone. Before claiming any prize, each winner must provide his/her correct name, address and telephone number to Station at the time of notification. Each winner (or if a minor, the parent/legal guardian) must sign and return a release and affidavit of eligibility, which must be received within three (3) days of notification (or less due to prize use time constraints), at the time winner claims his/her prize in person at the Station. Each winner must show picture identification to claim his/her prize. Station reserves the right to examine additional identification and may choose to accept or deny awarding any prize based on the identification presented.

5. If a winner cannot be notified within two (2) days, or does not sign and return the release and affidavit of eligibility on the same day, then the prize will be forfeited, and time permitting, the prize will be awarded to an alternate winner with the next highest score, as determined by the judges in their sole and absolute discretion. If time does not permit for an alternate winner to be determined, then the prize will be forfeited, and the prize will remain the property of the Station.

6. There will be no substitutions or cash alternatives for any prize except at the sole discretion of Station. The Station has the right to substitute a prize of similar value. No sale, transfer or assignment of any prize is allowed.

7. Each winner is responsible for paying all local, county, state and federal taxes on prizes based on the estimated retail value of the prizes as set forth in these rules. Each winner must sign a W-9 form.

8. Only one (1) prize will be awarded per household if more than one prize is awarded. Entrants (or nominee winners) are eligible to win only one prize within any ninety (90) day period, regardless of the number of contests entered.

9. The Company is not liable if the provider of any part of a prize fails to satisfy its obligations to furnish its portion of the prize.

10. The Company, Sponsor(s), Prize Provider(s), and Facebook accept no responsibility or liability in connection with any injuries, losses or damages of any kind directly or indirectly caused by or resulting from the acceptance, possession or use of any prize awarded in the Contest. By entering, entrants (and by accepting winner status, nominees) agree to release the Company, Sponsor(s), Prize Provider(s), contest software providers, social media platforms, and each of their respective parent, affiliates, officers, directors, employees and agents, from any and all claims, loss, damage or injury as a result of or incident to his/her participation in the Contest or his/her use of the prize. Entrants (and nominee winners) further acknowledge and agree that if a winner, the Company has the right to publicize entrant’s (or nominee’s) name, character, likeness, photograph, voice and the fact that you are a winner of the Contest for promotional purposes, without financial remuneration.

11. Complete Official Rules for the Contest are available Monday through Friday during normal business hours at the Station and on the Station’s Website. For a list of prize winners, send a separate, self-addressed, stamped envelope to the Station at the Station Address within thirty (30) days of the last day of the Contest Period.

12. The Station has the right to disqualify any entrant it determines has not complied with the Contest Rules. All decisions by the Station shall be final and binding relating to this contest, including the interpretation of the Contest Rules. Station reserves the right to make rules and contest changes and change the contest dates. Station reserves the right to cancel/terminate, modify or suspend the Contest if in Station’s sole determination it believes that the integrity of the Contest has been, or could be, compromised or that the Contest is not capable of running as planned or fairly, including infection by computer virus, bugs, tampering, unauthorized intervention, fraud, technical failures, or force majeure or any other causes beyond the Station’s control.

13. The Contest is subject to the Station’s Privacy Policy and the Station’s Website Terms and Conditions located on the Station’s Website.