THE BACHELOR / BACHELORETTE
NOMINATION
Today’s Date:
I am nominating a: ! Bachelor ! Bachelorette
Nominee’s Name:
Nominee’s City and State of Residence:
Nominee’s Contact Information:
Cell # Home #
Email: Age:
Birthdate: Hair Color:
Height: Weight: Eye Color:
Does the Nominee know you are nominating him/her for “The Bachelor/Bachelorette”? ! Yes ! No
Nominee’s occupation:
What is his/her highest level of education?
Does the Nominee have any children? ! Yes ! No
Tell us about the person you are nominating:
Is the Nominee a legal U.S. resident? ! Yes ! No
Page 1 of 2
THE BACHELOR / BACHELORETTE
NOMINATION
What is your relationship to the Nominee (optional)?
Your Name (optional):
Your Contact Information (optional):
Phone #
Email:
How did you hear about our search: ! Radio ! Television ! Magazine ! Other, explain______
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 the immediate elimination of my Nominee from consideration. I further understand that by submitting this questionnaire, the Producer has no obligation to me, and may use all information (including my personal information) as provided herein as the Producer in its sole discretion sees fit with respect to the Program and/or the selection process. 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., and 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 my Nominee and the selection and participation of my Nominee in “The Bachelor” or “The Bachelorette” is in no way guaranteed, as it is merely for the purpose of evaluating potential participants. I agree to indemnify and hold Producer harmless from and against any and all claims, losses, liabilities, damages and expenses, including reasonable attorneys’ fees, which may result from any breach of the representations and warranties herein.
Signature: Date:
You must include one or more recent pictures of the nominee (photos will not be returned). We do not accept nominations without a picture. Please mail to: THE BACHELOR/BACHELORETTE CASTING 11901 SANTA MONICA BLVD #595 LOS ANGELES, CA 90025
Page 2 of 2