Please note: the following eligibility requirements must be met in order to proceed with the application process.
  1. You must be willing to travel at your own expense to be interviewed in January 2000 (as scheduled by the Producers) at one of the following locations nearest you: New York City, New York; Philadelphia, Pennsylvania; Boston, Massachusetts; Pittsburgh, Pennsylvania; Baltimore, Maryland; Los Angeles, California; San Francisco, California; Denver, Colorado; Salt Lake City, Utah; Chicago, Illinois; Detroit, Michigan; Minneapolis, Minnesota; Green Bay, Wisconsin; Dallas, Texas; Austin, Texas and Miami, Florida.
  2. You must be willing to travel to Los Angeles for one week in January and/or February 2000 (as scheduled by the Producers) for the final selection process. Pre-approved economy travel (roundtrip to and from Los Angeles and your home in the United States) to be paid by Producers.
  3. You must be willing to travel to a remote island off of the coast of Borneo for seven (7) weeks in March and April, 2000. Economy travel to be paid by Producers.
  4. You must be at least 21 years of age.
  5. You must be a United States citizen and live in the United States.
  6. You must not now be a candidate for public office and must agree not to become one until after initial broadcast of all programs in which you appear, if selected as a contestant.
  7. You must be in excellent physical and mental health.
  8. If you are selected to be interviewed, you must timely complete and return (prior to the date of your personal interview) the completed Medical History Form, to be furnished to you by the Producers.
  9. To accept an invitation to be a semi-finalist, you must complete, and timely return the Competitor Form Package, which will be furnished to you by the Producers, and will include, among other things, a Competitor Affidavit, and the Competitor Agreement, including Release Forms and Waivers for you and your immediate family, and you must submit to physical and mental examinations, to be conducted in Los Angeles by medical professional(s) selected by Producer and meet all physical and psychological requirements.
  10. If you are selected as a semi-finalist, you agree to authorize Producers to conduct a background check.
  11. All semi-finalists must have a valid United States passport, and deliver a copy to Producers no later than February 1, 2000.
  12. Employees, officers, directors and agents of CBS Broadcasting Inc., DJB, Inc. and Eco Challenge Lifestyles, Inc., and/or of any of their respective licensees, assigns, parents, affiliated and subsidiary companies and the immediate family (spouse, mother, father, sister, brother, daughter or son, regardless of where they live) or members of their same households (whether related or not) of such employees, officers, directors and agents are not eligible to be contestants on Survivor! or participate in this application process.


Applications MUST be written clearly or typed and must be accompanied by a videotape which meets the following restrictions:

LENGTH: MAXIMUM OF THREE MINUTES Anything over three minutes will not be considered.

FORMAT: VHS, Hi-8. (no mini-DVs, 8mm, or VHS-C) We prefer VHS. To transfer the other formats toVHS simply connect your camera to your VCR and record.

CONTENT: Who you are and why you would make the ultimate Survivor! Be creative!

DEADLINE: Completed application with videotape must be received by December 10, 1999.

The videotape will be retained by Producers and will not be returned to you, whether or not you are selected as a contestant.

Applications will only be considered if they are complete. Complete applications consist of the following:
  1. Completed application form (including the signed name and likeness release) along with an attached passport-sized photo.
  2. Three-minute videotape labeled clearly with your name, age and phone number.
  3. Print clearly on the outside of the envelope the number ( 1 - 16 ) which corresponds to the city nearest you:
  1. New York City, New York
  2. Philadelphia, Pennsylvania
  3. Boston, Massachusetts
  4. Pittsburgh, Pennsylvania
  5. Baltimore, Maryland
  6. Los Angeles, California
  7. . San Francisco, California
  8. Denver, Colorado
  9. Salt Lake City, Utah
  10. Chicago, Illinois
  11. Detroit, Michigan
  12. Minneapolis, Minnesota
  13. Green Bay, Wisconsin
  14. Dallas, Texas
  15. Austin, Texas
  16. Miami, Florida


Send your application and video submission to the following address: Survivor!
9899 Santa Monica Blvd.
PMB 346
Beverly Hills, CA 90212

1) PERSONAL INFORMATION

First Name:
Last Name:

Nickname (if any): _______________________

Street Address:

City:
State:
Zip Code:

Phone Number (daytime):     (evening):

Fax Number: ________________________

Email address:

Gender (please circle):  M F

Age:    Date of Birth:



Marital Status / Significant Other:

If you have children, please list their names and ages:

What is your current occupation?:

In which other occupations, if any, have you been employed (please list your last three (3))?
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________


What is your level of education and what school(s) did you attend?
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________


Name three of your favorite hobbies.
(1) ____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
(2) ____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
(3) ____________________________________________________________________
____________________________________________________________________
____________________________________________________________________


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


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

If yes, please describe in detail, citing dates, diagnosis and any on-going problems:
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________


Please list any other allergies you have (medications, food, hay fever, dust, etc.) and your current treatment for them:
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
List three adjectives that best describe yourself:
(1)__________________________________
(2)__________________________________
(3)__________________________________


If you could hold any political office, what would it be and why?:
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________


What is the accomplishment you are most proud of?:
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________


Do you have any pets? If so, please list their name and type.:
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________


Are you a vegetarian or do you eat meat?:
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________


What's your favorite TV show?:
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________


What's your favorite movie?:
____________________________________________________________________
____________________________________________________________________
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What's your favorite music to listen to?:
____________________________________________________________________
____________________________________________________________________
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Describe your perfect day.:
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________


What magazines do you read?:
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________


Do you belong to any affiliations or organizations?:
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________


Do you have any body art (piercing, tattoos, etc.)? If so, please describe.:
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________


What's your favorite sport?:
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________


Who is your hero and why?:
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________


List three (3) items you would take with you to the Survivor! desert island, if allowed, and why?:
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________


What is your favorite topic of conversation at a dinner party?:
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________


What skills do you bring to the island that would make you a useful member of the group?
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________


Which former castaway would you be most identified with: Gilligan, Skipper, Professor, Mary Anne, Ginger, Mr. or Mrs. Howell and why:
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________


What personality traits will make you a valued member of the society?
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________


What types of people would you choose to have with you on island?
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________


What types of people would you NOT choose to have with you on the island?
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________


And the most intriguing question of all:


Why do you believe you could be the final Survivor? (please limit your answer to 3 or 4 sentences):
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________


Please read, sign and date the following statement:

I hereby acknowledge that: (i) I have read and agree to be bound by the eligibility requirements; (ii) I have answered the previous questions honestly and accurately; (iii) If any of the above information is found to be false, this will be grounds for my dismissal from the Survivor! contestant selection process, and/or from the Survivor! contest, if selected; (iv) Even if I meet the eligibility requirements, the Producers have no obligation to interview me, and/or select me as a contestant; (v) Even if I am selected as a contestant, Producers have no obligation to conduct the contest and CBS has no obligation to broadcast it, even if conducted and (vi) All decisions by Producer concerning selection of the contestants is final and not subject to challenge or appeal. Signature ______________________ Date _______________________

PLEASE SIGN AND DATE THE FOLLOWING NAME AND LIKENESS RELEASE.

By submitting this application I hereby consent to the recording, use and reuse by the producers of the Program (defined below) and CBS Broadcasting Inc. and any of their respective licensees, assigns, parents, subsidiaries or affiliated entities and each of their respective employees, agents, officers and directors (collectively "Releasees") of my voice, actions, likeness, name, appearance and biographical material (i.e., collectively "Likeness") in any and all media now known or hereafter devised, worldwide, in perpetuity, in or in connection with the reality based television series currently entitled SURVIVOR! (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 the application video that I have provided in connection with the Program (the "Video") and all rights therein and thereto including, without limitation, the right to use the Video and my Likeness in any and all media now known or hereafter devised, worldwide, in perpetuity. I further agree that Releasees may use my Likeness and the Video in connection with any promotion, publicity, marketing or advertisement for the Program. I grant the rights hereunder whether or not I am selected to participate in the Program in any manner whatsoever. I release Releasees from any and all liability arising out of its use of my Likeness and/or the Video. I agree not to make any claim against Releasees as a result of the recording or use of my Likeness and/or the Video (including, without limitation, any claim that such use invades any right of privacy and/or publicity).

I have signed this release on the ____________ day of _________________ , 19__.

Signature _____________________________

Name (Please Print or Type) _____________________________

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