THE AMAZING RACE ASIA (SEASON 4)

APPLICATION FORM

EACH MEMBER OF YOUR TEAM SHOULD COMPLETE A SEPARATE

APPLICATION FORM. BOTH APPLICATIONS SHOULD BE SUBMITTED
TOGETHER, ALONG WITH A VIDEOTAPE. PLEASE REVIEW THE
APPLICATION PROCEDURE AND ELIGIBILITY REQUIREMENTS
CAREFULLY BEFORE SUBMITTING YOUR APPLICATIONS. PLEASE
RESPOND COMPLETELY AND HONESTLY.

CITY OF RESIDENCE:

RELATIONSHIP TO TEAMMATE:

COUNTRY OF RESIDENCE:

NATIONALITY:

1) YOUR PERSONAL INFORMATION

First Name:
Last Name:
Nickname:
Street Address:
City:
State:
Zip:
Phone Number: (cell):
(home):
(work):
Fax Number:
E-Mail:
Gender (please circle): M / F
Age:
Height:
Date of Birth:
Social Security #: (applicable for US citizens who work in Asia)
Passport Number and Country of Issue:
Passport Expiration Date:
Number of blank pages in Passport:
Marital Status / Significant Other (check as applicable):
Single (with no significant other)
Boyfriend Name:
Girlfriend Name:
Married Name:
Divorced
Widowed
Do you have any children? Please list their first names and ages:
First Name: Age:

Are you licensed to drive a car? Yes / No

Drivers’ License Number/Country of Issue/Expiration Date:

Can you drive a car with: (a) manual transmission; (b) automatic
transmission (check all that apply)
How often do you drive? Daily? Weekly ( times per week)? Monthly?

What is the airport closest to your home?

2) TEAMMATE INFORMATION
Teammate’s First Name:
Teammate’s Last Name:
How long have you and your teammate known each other?
How did you meet?

What is the biggest disappointment you have experienced from your teammate?

How did you resolve it?

What famous person reminds you of yourself?

What famous person reminds you of your teammate?

What type of activities do you like to do with your teammate?

What time(s) together with your teammate are/have been the most memorable? Why?

What is the worst experience you have had with your teammate? Why?

How are you and your teammate most alike?

How are you and your teammate most different?

3) OTHER INFORMATION

Not including your current place of residence, in which other cities and/or countries
have you lived and for what period of time?

What most scares you about travelling?

What most excites you about travelling?

What is your opinion of foreigners?

Are there any locations in the world to which you absolutely will not travel? If so,
identify where and explain why.

Have you ever travelled outside of your country? If so, to where?

What language(s) do you speak?

What country and place would you most like to visit and why?

What part of the world is the least interesting to you and why?

Do you get sea, air or car sick? If yes, please state which.

What is your current occupation?

In which other occupations, if any, have you been employed (please list the last three)?
What is your level of education and what school(s) did you attend?

Name three of your favourite hobbies.

1.
2.
3.

Have you been treated for or experienced any physical or mental illness(es) within the
last ten years? YES / NO

(If Yes, please describe in detail, citing dates, diagnosis and any on-going problems):

Are you currently taking any medications? If yes, which ones, and why are you
taking them?

Please list any allergies you have (medications, food, hay fever, dust, etc.) and your
current treatment for them:

Have you ever been arrested? If so, describe when you were arrested, the
circumstances, charge(s), and whether or not you were convicted. If you were
convicted, describe the penalties imposed.

Are there any outstanding warrants for your arrest? If so, please explain the
circumstances.
Have you ever been subject to any non-judicial disciplinary or administrative hearings
or tribunal(s)? If so, explain the circumstance and the outcomes of such hearing(s) or
tribunal(s).

List the three adjectives that best describe you:

1.
2.
3.

What is the accomplishment that you are most proud of?

Have you ever been on television before? If so, when and what shows?

Have you ever appeared in a publicly released film or video of any sort? If so, when
and in which film(s) or video(s)?

Please list any advertiser / sponsorship affiliations that you currently have (or had
within the past 12 months) with any company for any product or service, including the
term of such affiliation (start and finish), relevant products and/or services and all
associated obligations and restrictions. Failure to disclose any such affiliation(s) may
result in your disqualification as a participant on the Program.

What is your favourite TV Show?

What is your favourite movie?

What is your favourite music to listen to?

Describe your perfect day:

What is/was the most exciting moment of your life?

Do you belong to any affiliations or organizations?

What are your phobias?

How do you feel about your family? Are you close?

How do you blow off steam?

What is your favourite topic of conversation at a dinner party? What topics are off
limits?

What are your biggest pet peeves about yourself?

What sports, hobbies or special skills do you have?

Do you know anybody involved in the production of THE AMAZING RACE ASIA?
If so, please explain your relationship.

What is your primary motivation for being on THE AMAZING RACE ASIA? What
is your secondary motivation for being on the show?
 RELEASE AND WAIVER

PLEASE READ, SIGN AND DATE THE FOLLOWING:

I hereby acknowledge that: (i) I have read and understand, and I meet and agree to be
bound by, the eligibility requirements for THE AMAZING RACE ASIA (the
"Program"); (ii) I have answered (and will answer) all questions posed to me as part
of the application process honestly, accurately and to the best of my ability and
knowledge; (iii) if any of the information that I provide to the Producers (as defined
below) is found to be false, this will be grounds for my dismissal from the Program
application process, and/or from the Program itself even if I am ultimately selected as
a participant; (iv) even if I meet the eligibility requirements, the Producers have no
obligation to interview me and/or select me as a participant; (v) even if I am selected
as a participant, the Producers have no obligation to produce the Program and AXN
has no obligation to broadcast it, even if it is produced; (vi) in the event the Program
is cancelled or not broadcast for any reason, the Producers and/or AXN or other
broadcasting television network will have no obligation to award any prize money;
(vii) all decisions by the Producers concerning selection of participants and other
matters is final and not subject to challenge or appeal; and (viii) the Producers own,
and are not obligated to return or maintain (and may destroy), any materials submitted
as part of my application (including, but not limited to, videotapes and photographs)
whether or not I am selected as a participant.

As used herein, the term “Producers” shall mean Active TV Pty Ltd, Active TV Asia
Pte Ltd, AXN Holdings, LLC (“AXN” or the “AXN Channel”), and each of those
companies’ respective licensees, assigns, parents, subsidiaries, divisions, business
units, or affiliated entities.

By submitting this application, I hereby consent to the recording, and use and reuse by
the Producers and each of their respective employees, agents, officers and directors
(collectively "Releasees") of my voice, actions, likeness, name, appearance and
biographical material (collectively “Likeness”) in any and all media now known or
hereafter devised, worldwide, in perpetuity, in any and all versions now known or
hereafter devised (including digitized versions) in, or in connection with, the Program.
I agree that Releasees 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
Releasees exclusively own all right, title, and interest in and to any application
materials (e.g. the video, any photos, etc.) that I have provided in connection with my
application for or participation in the Program and any photos and video or recordings
of any kind that the Producers may make of me in connection with the Program and
my application therefore (collectively, the “Material”) and all rights therein and
thereto including, without limitation, the right to use and exploit the Material and my
Likeness in any and all media now known or hereafter devised, worldwide, in
perpetuity, in any and all versions now known or hereafter devised (including
digitized versions). Without limiting the foregoing in any way, I further agree that
Releasees may use my Likeness and the Material in connection with any promotion,
publicity, marketing or advertisement for the Program or AXN in any manner
whatsoever. Without limiting the foregoing grant of rights in any way, to the degree
that the Materials include any pre-existing musical or literary compositions in which I
(partially or wholly) own the copyright or any publishing rights, or to which I purport
to (partially or wholly) own such copyright or publishing rights, I hereby grant to the
Producers, and have the complete, unfettered right to grant to the Producers, an
irrevocable, unlimited, perpetual, worldwide, royalty and payment-free license to use
and reproduce such Material in the Program and in connection with any promotion,
publicity, marketing or advertisement for the program or any exploitation of the
Program, in whole or in part, of any kind, in any and all media now known or which
may exist in the future. I understand that the Producers make no representation
whether or not such Materials will be used in any manner whatsoever. I irrevocably
and absolutely grant the rights hereunder whether or not I am selected to participate in
the Program. I release Releasees from any and all liability arising out of its use of my
Likeness and/or the Material (including, without limitation, any claim that such use
invades any right of privacy and/or publicity and any claims based on defamation or
libel or false light), and I represent and warrant that I have the right to grant the rights
conveyed hereunder. I understand that the Producers make no representation that the
Materials will or will not be used in any way.

This Release and Waiver 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 Release and Waiver, the breach thereof and/or the scope of the
provisions of this paragraph 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 agreement
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 the Producers, such other court that may have jurisdiction
over me, without thereby waiving its right to arbitration of the dispute or controversy
under this paragraph. 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 related to the Producers, their parents,
subsidiaries and affiliates, or the use, publication or dissemination of any advertising
in connection with such motion picture, production or project.

Without limiting the foregoing, any provision of this release that is invalid, illegal, or
unenforceable in any jurisdiction will, as to that jurisdiction, be ineffective only to the
extent of such invalidity, illegality or unenforceability, without affecting in any way
the remaining provisions hereof in such jurisdiction or rendering that or any other
provision of this release invalid, illegal or unenforceable in any other jurisdiction. No
waiver by the Producers of any term or condition of this release will be construed as a
waiver by the Producers of any other term or condition; nor will any waiver by the
Producers of any default under this release be construed as a waiver by the Producers
of any other default. It is further understood and agreed that no failure or delay in
exercising any right, power or privilege hereunder shall operate as a waiver thereof,
nor shall any single or partial exercise thereof preclude any other or further exercise
thereof or the exercise of any right, power or privilege hereunder. The Producers may
freely assign, in whole or in part, any of their rights or obligations under this release.
I may not assign my rights and obligations under this release.

I have signed this Application and Release and Waiver on the day of
, 2010.

Signature:

Print Name:

Date: