IMTWI2-Application-Form by facebookinfo2012

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									                                CONTESTANT APPLICATION
INSTRUCTIONS:

    1. Please fill out the Application legibly. Print it out and handwrite it.

    2. Use dark colored ink.

    3. Answer all questions honestly and to the best of your ability.

    4. Please write only on the printed side of the paper, but feel free to attach additional sheets if
       necessary.

    5. PLEASE, take your time and answer completely.

    6. References to the “Program” in the questionnaire refer to the reality-based game show program
       currently titled “Minute To Win It.” References to “Producer” refer to AXN Holdings, LLC and
       related entities as defined in the Application.

    7. To be selected as a participant in the Program, please note that you MUST (a) have a valid
       passport (that does not expire prior to April 2012) and (b) be eligible to travel outside of India
       and to enter any country in which the Program may be produced (as specified in the Eligibility
       Requirements set forth in Section II).



                                   The Application begins on the next page

                                   Please send all completed applications to:

                                                 AXN India
                                  c/o Multi Screen Media Private Limited
                                      Interface, Building 7, 4th Floor
                                           Off Malad Link Road
                                               Malad (West)
                                             Mumbai - 400 064
                                                   India




                         Thank you for your time and effort, and GOOD LUCK!



101027
                                                                                     CONTESTANT APPLICATION



                                              MINUTE TO WIN IT
                                             Contestant Application

Name:

Home Phone:                                                   Mobile:

Address:


Email:                                                        I check my email often: Y    /N
Part I: About Me
1)       Who is your current employer and what is your occupation? (What job pays your bills now?)




2)       Please list your last three jobs:
1.
2.
3.
3)       What levels of education have you completed (please specify school and major/subjects - e.g., High
School, College, Bachelors Degree, Masters Degree, Professional Degree, Doctorate):
School(s)/College(s):                          Major(s)/Subject(s):                        Year Graduated:




4)       Have you ever been in the military?    YES           NO      (Circle One)
If YES, please list (1) what branch; (2) dates of service; and (3) type of discharge:




5)       What are your most significant relationships (e.g., with your family, friends, employers, etc.)? How
long have you known these people?




                                                       p. 2
                                                                              CONTESTANT APPLICATION

6)    Do you have any children? If so, what are their names and ages?




7)    Who is the most important person in your life?


8)    Who do you live with and for how long?


9)    What would your friends say are your best qualities?




10)   What would your friends say are your worst qualities?




11)   How are you competitive in your everyday life?




12)   What is the next milestone in your life if you do not make the show?




13)   What’s the most interesting thing about you that a stranger wouldn’t know just by looking at you?




14)   Name a few random skills that you are good at:




15)   What is the most daring and dangerous thing you have ever done? Describe the circumstances:




16)   If you had to practice these games at home, who would you practice them with?




17)   Describe your most embarrassing moment:




                                                   p. 3
                                                     CONTESTANT APPLICATION

18)   What is the weirdest thing about you?




                                              p. 4
                                                                                    CONTESTANT APPLICATION



PLEASE LIST THREE (3) SUPPORTERS WHO YOU WOULD LIKE TO APPEAR WITH YOU ON
THE PROGRAM TO SUPPORT YOU IF YOU ARE SELECTED AS A CONTESTANT.
Supporter #1:
Name:                                                             E-mail address:
Home #:                                                           Mobile #:
Other #:
Supporter’s relationship to you:
Why do you want this Supporter with you on stage?


Supporter #2:
Name:                                                             E-mail address:
Home #:                                                           Mobile #:
Other #:
Supporter’s relationship to you:
Why do you want this Supporter with you on stage?


Supporter #3:
Name:                                                             E-mail address:
Home #:                                                           Mobile #:
Other #:
Supporter’s relationship to you:
Why do you want this Supporter with you on stage?

NOTE: In order to appear on the Program, supporters must (a) have a valid passport (that does not
expire prior to April 2012) and (b) be eligible to travel overseas and to enter any country in which the
Program may be produced.

Have you appeared on any game/talk/reality shows that have aired in the past 2 years, or which may air
within the next year?               If yes, please fill in the following:
            Show Name                             Air Date                      Amount Won
                                          (Include Tape Date if not yet aired)




[Use another sheet if additional space is necessary.]
                                                         p. 5
                                                                                   CONTESTANT APPLICATION


List all TV game or contest shows on which you have appeared, and whether or not you won any prizes. If
you have NOT appeared on any such shows, please state this. Do not leave the space below blank.




Have you applied to be on any TV shows in the past year?       YES       NO       (Circle One)

If YES, which ones?

Are you currently being considered for any other reality shows, including, without limitation, any game or
contest shows? YES        NO (Circle One)           If YES, which ones?



Have you ever been charged with any criminal offence?
If YES, please describe in detail, tell us when and where the event occurred, and what the outcome was:




Have you ever been convicted of any criminal offence?
If YES, please describe in detail, tell us when and where the event occurred and what the outcome was:




Have you ever had a temporary or permanent restraining order or injunction entered against you, or has
anyone tried to obtain a temporary or permanent restraining order or injunction against you?


If YES, please give details, including, without limitation, date(s), place(s) and name(s) of party(ies) seeking
the temporary restraining order or injunction and relationship of such party to you, and a description of the
basis upon which the temporary restraining order or injunction was sought, whether it was issued, and the
basis upon which it was issued:




Is there any pending litigation, arbitration, inquiry or other adverse proceeding against you?


If YES, please describe when and where the event(s) occurred, the other party(ies) to the proceeding(s),
whether you were the plaintiff or defendant, the nature of the proceeding(s), and what the outcome was for
each proceeding:




                                                      p. 6
                                                                                      CONTESTANT APPLICATION

Have you ever been evicted? YES                NO (Circle One)
If YES, please give details, places and dates:




Have you ever been the subject of disciplinary proceedings or actions in school, college, in the military, at
work or in any other context?        YES       NO       (Circle One)
If YES, describe in detail, including, without limitation, date(s), place(s), the setting, the exact nature of the
charges and proceedings, and the actions taken in connection with the charges and/or proceedings:




Have you ever done or been involved in anything that would reflect negatively on you or on the Program,
the Producer and/or the television networks or channels that telecast the Program if you are chosen to
participate in the Program? YES            NO           (Circle One)
If YES, please explain in detail, including, without limitation, date(s), place(s), person(s) involved and their
relationship to you, context, setting, publicity (if any) and the exact nature of the incident(s):




Have you ever created a website or posted any materials on any website? YES              NO      (Circle One)
If YES, describe the website(s) you created and/or the materials you posted:




Have you appeared in any magazines, publicly disseminated photographs, advertisements or the Internet?
YES      NO (Circle One)
If YES, please describe:




Do you know anyone else who is applying to be on the Program (other than your supporters)?
YES       NO (Circle One)
If YES, please list their name(s) and number(s):




                                                        p. 7
                                                                              CONTESTANT APPLICATION

Is there anyone among your family, friends, or work colleagues that would object to you appearing on
television? YES NO (Circle One)
If YES, please identify all such persons, including your relationship with them and the reason they would
object:




                    PLEASE CONTINUE TO PART II OF THE APPLICATION




                                                   p. 8
                                                                             CONTESTANT APPLICATION

     PART II: ELIGIBILITY REQUIREMENTS, REPRESENTATIONS AND RELEASES

Eligibility Requirements

1)     You must be at least 18 years of age, and you must be of sound mind and not disqualified or
       prohibited under any law or contract from entering into any agreement in respect of the
       Program (as defined below).

2)     You must be a legal Indian resident and/or living and/or working in India.

3)     You must be proficient in reading, writing and speaking the English language.

4)     You must not be a candidate for public office and must agree not to become one until after the
       initial telecast of the episodes of the Program in which you appear, if selected as a participant.

5)     You may not participate in the Program if your participation would create impropriety or the
       appearance of impropriety. In making this determination, Producer will consider whether you,
       any member of your immediate family or anyone living in your household is or has been
       within the last two (2) years an employee, officer, director, agent or representative of any of
       the following:

       (a) Producer or any television production company, network, channel or distributor
           owned or operated by Sony Pictures Television or NBC Universal;

       (b) Producer, or any other person or entity any person or entity involved in the
           development, production, distribution or other exploitation of the reality-based
           game show program currently titled “Minute To Win It” (the “Program”) or any
           variation thereof;

       (c) Any sponsor of the Program or its advertising agency; or

       (d) Any person or entity supplying prizes or other services to the Program.

Please list any such relationships here; if none, write “None.”
__________________________________________________________________________________
__________________________________________________________________________________

In addition, Producer reserves the right to render ineligible any person whom it determines, in its sole
discretion, is sufficiently connected with the production, administration, judging or distribution of the
Program, such that his or her participation in the Program could create the appearance of impropriety.

6)     If selected as a participant you must execute waivers and release agreements required by
       Producer or any of its licensees, successors or assigns.

7)     You must be willing to submit to a background check.

8)     You will need to be willing to travel to the production location, to be determined. The
       production location is expected to be in Malaysia, but could be in any other country. To be
       selected as a participant, please note that you MUST (a) have a valid passport (that does
       not expire prior to April 2012) and (b) be eligible to travel outside of India and to enter
       any country in which the Program may be produced.

                                                    p. 9
                                                                              CONTESTANT APPLICATION


Representations, Warranties, Acknowledgements, Consents and Releases

You hereby give the following representations, warranties, acknowledgements, consents and releases:

       (a)    I desire to voluntarily participate in interviews and auditions (the “Activity”) for the
              Program. In connection with my participation in the Activity and/or the Program, and
              by signing below, I hereby represent, warrant, acknowledge, and agree that:

              (i)    I have read, and confirm that I satisfy, the eligibility requirements;
              (ii)   I have completed this Application honestly and accurately;
              (iii)  If any of the information in this Application is found to be false or incomplete,
                     this will be grounds for dismissal from the Program participant selection
                     process and/or from the Program contest (if any), if selected;
              (iv)   Even if I meet the eligibility requirements, Producer has no obligation to
                     interview me, and/or select me as a participant;
              (v)    Even if I am selected as a participant, Producer has no obligation to conduct the
                     Program contest (if any), produce the Program or telecast the Program even if
                     produced;
              (vi)   All decisions by Producer concerning selection of the participants are final and
                     not subject to challenge or appeal;
              (vii) Producer has no obligation to return any materials submitted by me as part of
                     this Application whether or not I am selected as a participant;
              (viii) I am in good health and I have no mental, physical or emotional condition that
                     might interfere with my engaging in the Activity or participating in the
                     Program;
              (ix)   I am not under the influence of any medication, drugs or other substance that
                     might impair my physical or mental ability to engage in the Activity or that
                     might impair my judgment while engaging in the Activity or participating in the
                     Program;
              (x)    I will follow all rules made and directions given by Producer and its
                     representatives in connection with the Activity and/or the Program; and
              (xi)   I agree to keep strictly confidential all information about the Activity and the
                     Program that I acquire during the participant selection process and/or my
                     participation in the Program.

       (b)     By submitting this Application, I hereby consent to the recording, use and reuse by
       Producer and any of its licensees, successors, assignees, parents, subsidiaries or affiliated
       entities, and each of their respective employees, agents, representatives, officers and directors
       (collectively, “Releasees”) of my voice, actions, likeness, name, appearance, biographical
       material, and any information contained in, derived from or obtained in connection with my
       Application to be a participant in the Program or in any materials submitted by me in
       connection with my Application (collectively, “Likeness”), as edited, altered, or modified by
       Producer or by any of the other Releasees, in any and all media now known or hereafter
       devised, worldwide in perpetuity, in or in connection with the Program or any related work. I
       agree that the Releasees or any of them may use all or any part of my Likeness and may alter
       or modify it regardless of whether or not I am recognizable. I further agree that the Releasees
       exclusively own all right, title and interest (including, without limitation, all copyrights) in and
       to any and all recordings made by them and in and to any and all audiovisual materials that I
       have provided in connection with my Application and any other materials that I have provided
       or may provide in connection with my Application or the Program (collectively, the
       “Materials”) including, without limitation, the right to edit, alter or modify the Materials and to
                                                   p. 10
                                                                   CONTESTANT APPLICATION

use all or part of the Materials and my Likeness in any and all media now known or hereafter
devised worldwide, in perpetuity. Without in any way limiting the foregoing, if I perform or
include any music (other than music supplied to me by Producer) in connection with my
Application or the Program, I represent and warrant that I own all rights to such music, and I
grant Producer the right to record, reproduce and publicly perform any such music in and in
connection with the Program or any related work, worldwide, in perpetuity. Without in any
way limiting the waivers and releases set forth herein, I waive any claims to royalties of any
kind, whether accruing now or in the future, from Producer for the use of any such music
including, without limitation, any applicable copyright, public performance, mechanical and
synchronization royalties. I further agree that Releasees may use my Likeness and the
Materials in connection with any promotion, publicity, marketing or advertisement. I grant the
rights hereunder whether or not I am selected to participate in the Program in any manner
whatsoever. I understand that I will not be paid any money for giving Releasees these rights or
for signing this Application.

(c)   MY PARTICIPATION IN THE ACTIVITY IS AT MY OWN RISK. TO THE
MAXIMUM EXTENT PERMITTED BY LAW, I AGREE NOT TO SUE RELEASEES,
AND I RELEASE RELEASEES FROM ANY AND ALL CLAIMS, ACTIONS OR
LIABILITIES FOR INJURY OR DAMAGE TO ME, TO ANYONE ELSE OR TO ANY
PROPERTY IN ANY WAY RESULTING FROM MY PARTICIPATION IN THE
ACTIVITY, REGARDLESS OF WHETHER OR NOT SUCH INJURY OR DAMAGE WAS
CAUSED BY THE NEGLIGENCE OR WILLFUL MISCONDUCT OF RELEASEES OR
ANYONE ELSE CONNECTED WITH THE PROGRAM. THE FOREGOING INCLUDES,
BUT IS NOT LIMITED TO, ANY AND ALL LIABILITY ARISING OUT OF THE
RECORDING OR USE OF MY LIKENESS AND/OR THE MATERIALS INCLUDING,
WITHOUT LIMITATION, ANY CLAIM THAT SUCH USE DEFAMES ME, PLACES ME
IN A FALSE LIGHT OR INVADES ANY RIGHT OF PRIVACY AND/OR PUBLICITY.
THE RELEASED CLAIMS SPECIFICALLY INCLUDE, WITHOUT LIMITATION, ANY
AND ALL CLAIMS, ACTIONS, DAMAGES, LIABILITIES, LOSSES, COSTS AND
EXPENSES OF ANY KIND RESULTING FROM THE ACTIONS OF ANOTHER
PARTICIPANT OR ANY OTHER THIRD PARTY AT ANY TIME.

TO THE MAXIMUM EXTENT PERMITTED BY LAW, I WAIVE ANY AND ALL
RIGHTS I MAY HAVE UNDER SECTION 1542 OF THE CIVIL CODE OF CALIFORNIA,
AND EVERY LIKE PROVISION IN ANY OTHER JURISDICTION. SECTION 1542
PROVIDES AS FOLLOWS:

     A GENERAL RELEASE DOES NOT EXTEND TO CLAIMS WHICH THE
     CREDITOR DOES NOT KNOW OR SUSPECT TO EXIST IN HIS OR HER
     FAVOR AT THE TIME OF EXECUTING THE RELEASE, WHICH IF
     KNOWN BY HIM MUST HAVE MATERIALLY AFFECTED HIS OR HER
     SETTLEMENT WITH THE DEBTOR.

(d)     I understand that it may be unlawful, unless disclosed to Producer prior to the
exhibition of the Program, if any, to do any of the following: (a) give or agree to give any
member of the production staff and anyone associated in any manner with the Program or any
representative of Producer any portion of my compensation or anything else of value to arrange
my appearance in the Program; or (b) accept or agree to accept anything of value to promote
any product, service or venture on the air or to use any prepared material containing such a
promotion. I represent and warrant that I gave nothing of value nor did I agree to give
anything of value to anyone so I could be in the Program. I know that Producer does not
permit it and that it may be unlawful not to tell Producer if I had. I shall immediately notify
                                          p. 11
                                                                              CONTESTANT APPLICATION

       Producer and network or channel on which the Program will air if any person attempts or has
       attempted to induce me to do anything in violation of the foregoing or which is in any way
       dishonest.

As used herein, “Producer” shall mean AXN Holdings, LLC and its licensees, successors and assigns,
and each of their respective officers, directors, parents, subsidiaries, shareholders, employees, agents
and representatives. I agree that Producer may license, assign or otherwise transfer this Application
and all rights granted by me under this Application to any person or entity.

Whenever possible, each provision of this Application shall be interpreted in such manner as to be
effective and valid under applicable law, but if any provision of this Application is held to be
prohibited by or invalid under applicable law, such provision shall be ineffective only to the extent of
such prohibition or invalidity, without invalidating the remainder of such provision or the remaining
provisions of this Application.

I am proficient in reading, writing and speaking the English language and have fully read, understand,
and agree with the foregoing, and have voluntarily chosen to sign this Application.

This Application shall be governed by and construed in accordance with the laws of the State of
California, United States of America, without regard to choice of law principles. All actions or
proceedings arising in connection with, touching upon or relating to this Application, the breach
thereof and/or the scope of the provisions of this Application shall be submitted to JAMS (“JAMS”)
for final and binding arbitration under its Comprehensive Arbitration Rules and Procedures if the
matter in dispute is over US$250,000 or under its Streamlined Arbitration Rules and Procedures if the
matter in dispute is US$250,000 or less, to be held in Los Angeles County, California, in the English
language before a single arbitrator who shall be a retired judge, in accordance with California Code of
Civil Procedure §§1280 et seq. The arbitrator shall be selected by mutual agreement of the parties or,
if the parties cannot agree, then by striking from a list of arbitrators supplied by JAMS. The
arbitration shall be a confidential proceeding, closed to the general public. The arbitrator shall assess
the cost of the arbitration against the losing party. In addition, the prevailing party in any arbitration
or legal proceeding relating to this Application shall be entitled to all reasonable expenses (including,
without limitation, reasonable attorneys’ fees). Notwithstanding the foregoing, the arbitrator may
require that such fees be borne in such other manner as the arbitrator determines is required in order
for this arbitration clause to be enforceable under applicable law. The arbitrator shall issue a written
opinion stating the essential findings and conclusions upon which the arbitrator’s award is based. The
arbitrator shall have the power to enter temporary restraining orders and preliminary and permanent
injunctions. Neither party shall be entitled or permitted to commence or maintain any action in a court
of law with respect to any matter in dispute until such matter shall have been submitted to arbitration
as herein provided and then only for the enforcement of the arbitrator’s award; provided, however, that
prior to the appointment of the arbitrator or for remedies beyond the jurisdiction of an arbitrator, at any
time, either party may seek pendente lite relief in a court of competent jurisdiction in Los Angeles
County, California or, if sought by Producer, such other court that may have jurisdiction over me,
without thereby waiving its right to arbitration of the dispute or controversy under this Application.
Without prejudice to any other rights or remedies which Producer may have, I acknowledge and agree
that damages would not be an adequate remedy for any breach of this Application and the remedies of
injunction, specific performance and other equitable relief from a competent court with jurisdiction
over me are appropriate for any threatened or actual breach of this Application, for the protection of
Producer’s rights and in the interest of the Program. Notwithstanding anything to the contrary herein,
I hereby irrevocably waive any right or remedy to seek and/or obtain injunctive or other equitable
relief or any order with respect to, and/or to enjoin or restrain or otherwise impair in any manner, the
production, distribution, exhibition or other exploitation of any motion picture, production or project

                                                   p. 12
                                                                               CONTESTANT APPLICATION

related to Producer, its parents, subsidiaries and affiliates, or the use, publication or dissemination of
any advertising in connection with such motion picture, production or project.



Signature:

Date:

Name (Please print):

Date of birth:




                                                    p. 13

								
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