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All participants must provide
the following documents when submitting the Participant Questionnaire.
Failure to do so will result in delaying the processing of
your Participant Questionnaire and/or may result in eliminating
you from further consideration:
Recent Photograph
Photocopy of Current Drivers License
Social Security Number
I acknowledge that all the
information provided on this questionnaire is true and accurate,
and any false or misleading information submitted herein is
grounds for my immediate elimination from consideration. This
questionnaire and any other material submitted by me, including,
but not limited to, pictures, film and videotapes, becomes
the property of And Syndicated Productions, Inc., shall not
be returned and may be used in any manner in all media, worldwide,
in perpetuity. I further understand that by submitting this
questionnaire, Producer has no obligation to accept me and
my selection and participation in the above referenced programs
is in no way guaranteed, as it is merely for the purpose of
evaluating potential participants.
Grant of Rights: For
good and valuable consideration, receipt of which is hereby
acknowledged, I irrevocably grant to AND Syndicated Productions,
Inc. and its owners, principals, agents, licensees, affiliated
and related companies and assigns (collectively and individually
"AND"), the following rights (hereinafter "Rights
and Materials"): to interview (on and off-camera), to
record on film, tape or otherwise the following: my name,
likeness, image and/or voice; my on and off camera interview(s),
story(ies), activities and performance(s) (hereinafter “Taped
Activities”); and other material or information provided
by me (including, but not limited to, any video, stills, depictions
and/or applications or other materials submitted by me, of
which I am the sole copyright owner); my biographical material;
and my surroundings. My Taped Activities may include, but
shall not be limited to,___________________________________________________________________
____________________________.
I acknowledge and further agree that AND has the perpetual,
irrevocable and unencumbered right (but not the obligation)
to use, distribute and exhibit (and/or to authorize others
to use, distribute and exhibit) all or part of the Rights
and Materials in any and all media now known or hereafter
discovered, in perpetuity, throughout the world, including
without limitation, in and in connection with segments of
a reality dating/relationship television series (the "Program")
or in any other program, (and in connection with all ancillary,
incidental and subsidiary rights related thereto ), and in
television, radio, and other advertisements and promotions
for the Program (the "Advertisements") and other
programs; and to edit the Rights and Materials, and the Program
as AND wishes. I also understand and agree that AND may assign
this agreement in whole or part and the rights granted herein
shall inure to the benefit of AND, its licensees, successors,
and agents.
2. Release: I WILL NEVER
SUE AND OR ANYONE BECAUSE 1) AND, ITS LICENSEES, SUCCESSORS
AND ASSIGNS DID NOT TAKE OR USE THE RIGHTS AND MATERIALS GIVEN
BY ME; OR 2) I DO NOT LIKE THE MANNER IN WHICH THEY TOOK OR
USED THE RIGHTS AND MATERIALS GIVEN BY ME. I HEREBY RELEASE
AND FROM AND AGAINST ANY AND ALL CLAIMS, DEMANDS AND CAUSES
OF ACTION OF EVERY KIND AND NATURE, WHICH I MAY NOW HAVE OR
MAY HEREAFTER ACQUIRE, ARISING OUT OF OR IN CONNECTION WITH
MY APPEARANCE AND PARTICIPATION IN THE PROGRAM, INCLUDING
WITHOUT LIMITATION, ANY CLAIMS, DEMANDS AND CAUSES OF ACTION
FOR PERSONAL INJURY, INVASION OF PRIVACY OR PUBLICITY, DEFAMATION,
INFLICTION OF EMOTIONAL DISTRESS AND ANY OTHER TORT IN CONNECTION
THEREWITH.
3. Use of Rights/No Revocation:
I understand that AND is not obligated to use any of the Rights
and Materials granted herein. I know AND will incur expenses
in reliance on this Agreement, so I will not revoke it.
4. Entire Release: In
signing this Release, I have not relied on any representations
or other statements which are not contained in this Release.
No promises have been made to me other than as set forth in
this Agreement. I understand and agree that no oral agreements
are binding on AND unless and until reduced to writing and
signed by a duly authorized representative or officers of
AND.
5. Confidentiality:
I acknowledge that in the course of my participation in the
Project, I may gain access to confidential information, trade
secrets, records, data, and other information (hereinafter
collectively the “Information”) relating to the
Project (including, without limitation, the identities of
the participants and/or the outcome or content of any episode).
I understand and agree that all such Information is and shall
remain the property of AND and/or its related or affiliated
entities. I further agree that unless and until AND discloses
such Information to the general public, I shall not, without
the prior written consent of AND, disclose, or cause to be
disclosed, any such Information to any third party or entity,
for any reason or purpose whatsoever. I understand and acknowledge
that I shall be held fully responsible for all costs and damages
incurred by AND which result from my breach of my confidentiality
obligations, and that such costs may include the costs of
production.
6. Other: AND shall
exclusively own the copyright in and to the Rights and Materials
and any use and/or recordings made utilizing the Rights and
Materials and AND has complete and sole discretion as to their
use. I represent and warrant that I have the full right, power
and authority to grant the rights herein granted. Under penalties
of perjury I certify that the information, materials and representations
given or made by me which are contained on this form are true
and correct. This Release shall be performed at least in part
in California whose law shall govern and whose courts shall
have exclusive jurisdiction over any dispute relating to this
Release. I understand that upon my execution of this Release,
a duly authorized officer of the AND will counter-execute
this Release.
7. I understand that
it is a Federal offense and therefore I agree not to give
anyone associated in any manner with the Program anything
of value for arranging my appearance in the Program, or to
accept or agree to accept anything of value to promote any
product, service or venture in said Program, or to use any
material containing such a promotion where I know the preparer
of the material received consideration for its inclusion.
I acknowledge that I have read
and fulfill the eligibility requirements and all the information
provided on this questionnaire is true and accurate, and any
false or misleading information submitted herein is grounds
for my immediate elimination from consideration.
Signature________________________________ Date:_________
Mail the Bachelor/Rich Guy
Poor Guy/Bachelorette Application, photos, and video tape
of yourself telling why you should be a participant to the
following address:
(photos and videotapes will not be returned)
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Mail In:
Rich Guy Poor Guy C/O Submissions
14622 Ventura Blvd #531
Sherman Oaks, CA 91403
Phone Number: 866-825-1870
Fax Number: 818- 972-0996
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