NowhereMan
06-24-2005, 12:17 AM
you get on the show you get the bike,
they named it right,Fantasy,
they want to know everything about ya though,dont think im exceptable.lol
wouldnt even bother myself but thought maybe somebody might want to.
if ya do and ya win
ya owe me a fat bag for pionting this out,
afterall you be on tv and get piad ( have a nice bike)
http://dsc.discovery.com/fansites/amchopper/amchopper.html
--------------------------------------------------------------------------
??American Chopper Fantasy Bike?
Application Form
Part 1: General Info about the American Chopper Fantasy Bike episodes and the Application Process
Four people will be chosen by American Chopper Productions Inc. to participate in the American Chopper Fantasy Bike episodes, get the opportunity to meet Paul Teutul Sr. and Paul Teutul Jr. (??the Teutuls?) while they build your fantasy bike! ??American Chopper? (??Series?) is co-produced by American Chopper Productions Inc. (??Producers?) and Discovery Communications Inc. (??DCI?). The Producers will select the participants to be featured as part of this TV programming at their sole discretion.
Eligibility Requirements:
· You must be at least 21 years old.
You must be a legal U.S. resident.
You must not be a candidate for elected public office, and if selected as a participant, you will not become a candidate for elected public office until 12 months after the initial broadcast of the last episode of the series in which you appear.
You must never have been convicted of a felony and have never had a restraining order or other injunctive relief entered against you. There must not be any outstanding criminal warrants against you.
You must be willing to submit medical information to Producers and submit to a medical examination, psychological examination and background check.
Neither you, nor any of your immediate family members (spouse, ex-spouse, parents, siblings, children, regardless of where they live) and household members (whether related or not) may be or know any employees, officers, directors, representatives or agents of Producers, DCI, Orange County Choppers, known sponsors of the series or their advertising agencies, any cable service provider of DCI programming, and/or any of their respective parent, subsidiary, or affiliated companies, licensees, partners or assigns.
You must be ready to travel at a moment??s notice as determined by Producers at their sole discretion, and be available for approximately three weeks during production of the Fantasy Bike episodes of the series.
The Application Process:
To be chosen to participate in an American Chopper Fantasy Bike episode, you will need to fill out an application and send in a videotape. The main purpose of the video and application is for us to meet you and your family, and to find out about your fantasy bike and why you deserve to be on an episode of American Chopper. The more you tell us, the better!
For the Video:
The Teutuls and OCC will be screening these tapes, so feel free to address them in your video as you tell them your story and explain why they should choose you.
Do you have a compelling story?
Why do you deserve to be on the show?
What would meeting the Teutuls, going to OCC and watching your fantasy bike being built mean to you? How would it affect your life?
Be yourself -- let your personality shine through.
Please know this tape could be used on television, so make sure appearances are fit for TV!
Be creative and have fun!
For the application:
Take the time to answer questions on the application completely and thoroughly.
Don??t be limited by the space allotted on the application! Feel free to continue your answers on a separate sheet if needed.
Your next steps are:
Carefully read, fill out and sign this application with the Terms and Conditions, Waiver and Release of Liability (one per applicant, please).
Send us a three-minute videotape in which you tell us why you should be picked for an American Chopper Fantasy Bike episode. Producers will only consider tapes up to three minutes in length (VHS only, no MiniDV, Hi8 etc., please). Any and all materials submitted to DCI and/or the Producers as part of this application shall become the property of Producers and shall not be returned. The tape may be used as part of the Series or as part of the promotion of the Series.
Mail your application materials by the postmark deadline of July 31, 2005. Producers and DCI reserve the right to extend this deadline at their sole discretion and to change the application in parts or in its entirety.
Again, limit is one application per applicant.
Part 2: Application
Are you nominating yourself? YES NO
Are you nominating someone else? YES NO
If you are nominating someone else, have you spoken with them and are they interested in being nominated? YES NO
If you are nominating someone else, please give us your name and phone number, as well as relationship to the nominee:
Name: Phone Number:
Relationship to nominee:
(The rest of the application is in regards to the nominee.)
Your/Nominee??s First Name: Last Name:
Nickname(s):
Address:
City: State: ZIP:
Phone Number (home): (work):
Fax Number: Cell Phone Number:
Email:
Social Security Number (will be kept confidential):
Gender: M or F
Date of Birth:
Occupation:
Marital Status:
BOYFRIEND or GIRLFRIEND How long? _______________________
MARRIED How long? _______________________
NOT MARRIED, BUT LIVING WITH SIGNIFICANT OTHER How long? ______
SEPARATED How long? _______________________
DIVORCED How long? _______________________
WIDOWED How long? _______________________
Number of children:
Names and ages of children:
Spouse??s name and telephone number:
Siblings?? name(s) and telephone number(s):
Best friend??s name, address and telephone number:
Emergency contact??s name and telephone number:
Are you currently taking medication? Yes (if yes, please list) No
Do you have ongoing health problems? Yes (if yes, please list) No
Do you currently or did you in the past use any drugs, alcohol or are you having any kind of addiction?
Yes (if yes, please list) No
Have you ever been charged with a felony or misdemeanor, other than minor traffic or parking violations?
Yes (if yes, please list) No
Have you ever had a restraining order entered against you or have you been involved in any type of litigation?
Yes (if yes, please list) No
Have you appeared on television before? If so, when and what shows?
Do you belong to any affiliations or organizations?
What are your favorite activities?
What would it mean to you to have your very own American Chopper Fantasy Bike?
Do you have a favorite bike produced on American Chopper? If so, which one and why?
Do you currently own a motorcycle/chopper? If so, how many and what kind(s)?
Have you ever owned a motorcycle/chopper? If so, how many and what kind(s)?
What would it mean to you if you were chosen to participate in a Fantasy Bike episode?
Do you have a favorite memory involving a chopper/motorcycle? If so, explain.
What is your primary motivation for applying for the Fantasy Bike episode (i.e., working with the Teutuls, getting a new bike, being on TV, etc.)?
Tell us why you deserve an American Chopper Fantasy Bike.
Describe your fantasy bike.
If you were chosen, who would be involved in the process with you (i.e., wife, husband, parents, kids, friends, siblings, etc.)?
What qualities do you admire most in others?
How do most people describe you?
Part 3: Terms and Conditions, Waiver and Release of Liability
By submitting an application, each applicant agrees to release, discharge, indemnify and hold harmless Producers, DCI, Orange County Choppers known sponsors of the Series or their advertising agencies, any cable service provider of DCI programming, and/or any of their respective employees, officers, directors, representatives, agents, parent, subsidiary, or affiliated companies, licensees, partners or assigns from any and all claims and damages arising out of his/her participation in the application process or the Series itself.
Applications will only be considered if they are complete. Complete applications consist of the following:
Completed application form (including all of the questions answered and the fully executed Terms and Conditions, Waiver and Release of Liability).
Three-minute videotape labeled clearly with your name, address and contact numbers.
A recent (not older than 6 months, please) photo, stapled to the application form.
Photocopy of a valid U.S. driver??s license.
Social Security number.
Please send applications to: American Chopper Productions, Inc.
13351-D Riverside Drive #437
Sherman Oaks, CA 91423
By signing this application, applicant confirms that he/she is willing to:
Be ready and available to be accepted as a participant and, if selected as a participant, to travel without any prior notice as determined by the Producers and DCI at their sole discretion.
Abide by all applicable U.S. and state laws during the application process and, if selected, during the period in which the Fantasy Bike episodes of the Series are being taped.
Upon signing release forms as may be required by Producers that applicant is aware that all activities in the Series may expose applicant to significant risks and hazards, including death, serious injury, illness and property damage caused by the participation in the Series. Applicant does hereby agree to release, discharge, indemnify and hold harmless Producers, DCI, Orange County Choppers, known sponsors of the Series or their advertising agencies, any cable service provider of DCI programming, and/or any of their respective employees, officers, directors, representatives, agents, parent, subsidiary, or affiliated companies, licensees, partners or assigns from any and all claims and damages arising out of applicant??s participation in the application process or the Series, if applicant injures himself/herself or a third party, or if applicant or a third party suffer any property damage.
Applicant agrees that applicant??s name, voice and likeness may be used in perpetuity as part of the Series or any other program of Producers or DCI, or as part of the advertising, publicity and promotion for the Series, in any and all media now known or hereafter devised.
Applicants must agree to receive all medical exams and immunizations that Producers deem necessary and/or medically appropriate. Applicants must be willing to participate in the Series without any interruption during any time of the year, regardless of personal or religious practices.
Applicant shall be required to sign these Terms and Conditions, Waiver and Release of Liability. If applicant is selected to participate, before applicant can participate in any manner whatsoever with respect to the Series, applicant shall be required to re-execute this document (as amended, if required by Producers at their sole discretion), and to sign a Participant??s Release and a Confidentiality Agreement and any other documents that Producers deem necessary for applicant to participate in the Series (all of which will be furnished to the applicant after being told by Producers that his/her application has been approved). In addition, as part of these Terms and Conditions, Waiver and Release of Liability, applicant must agree among other things, to assume the risk of any and all injury, illness, death, damage, loss, or harm to applicant or applicant??s property, howsoever caused, resulting from or arising out of the selection of applicant, applicant??s participation in the Series, and/or the production and/or exploitation of the Series. By agreeing to the terms of the Confidentiality Agreement, applicant will be required to, among other things, treat all information and material received or acquired in connection with applicant??s participation in the selection process and Series (if selected), including, without limitation, the progress, results and outcome of the Fantasy Bikes, as strictly confidential and shall be strictly required to not disclose any such information to any third party. Without limiting Producers?? right to obtain other relief from applicant, any breach of the Confidentiality Agreement will subject applicant to substantial liquidated damages in accordance with the terms of the Confidentiality Agreement.
If applicant is selected, applicant agrees to authorize Producers to conduct a thorough investigation into applicant??s background and personal history (including, without limitation, applicant??s medical and psychological history).
Applicant must not now be a candidate for public office and must agree not to become one until 12 months after initial broadcast of all episodes of the Series in which applicant appears, if selected as a participant.
Employees, officers, directors, representatives and agents of Producers, DCI, Orange County Choppers, known sponsors of the Series or their advertising agencies, any cable service provider of DCI programming, and/or any of their respective parent, subsidiary, or affiliated companies, licensees, partners or assigns and the immediate family (spouse, ex-spouse, parents, siblings, children, regardless of where they live) or household members (whether related or not) of such employees, officers, directors, representatives and agents or anyone who knows such above listed persons are not eligible to be applicants on the Series or participate in the application process. Furthermore, applicant represents that he/she does not know anyone at the above-mentioned companies.
Due to the high volume of applications, Producer cannot respond to every applicant who applies to appear on the Series.
Producers reserve the right to stop applicant??s participation in the Series at any time for any reason, including but not limited to health, safety, legal and other reasons at their sole discretion, with no further liability to applicant. Applicant agrees to accommodate production needs as it relates to technical requirements, scheduling changes, production requirements, etc. as deemed necessary by Producers at their sole discretion. Producers reserve the right to change or amend this application at their sole discretion. All decisions of Producers are final and at their sole discretion.
Producers shall not be liable for any problems or delays with respect to, but not limited to, acts of god, war, riots, travel delays, human, technical, mechanical or electronic malfunctions or any individual??s inability to apply or participate in the Series. Producers reserve the right to decide whether to continue the realization of a Fantasy Bike and to change, alter or add to a Fantasy Bike, at their sole discretion.
The selection of the applicants will be made by the DCI, Producers and the Teutuls based on such criteria as DCI, Producers and the Teutuls shall solely determine which criteria may be highly subjective. DCI, Producers and the Teutuls are not obligated to select anyone, even if someone meets all eligibility requirements and all criteria for selection. Producers??, DCI??s and the Teutuls?? decisions regarding the number and selection of applicants are final and not subject to challenge or appeal. Producers also reserve the right to change the format of the Series, to change the application process, the rules and process of the participation, and the elements of the actual Fantasy Bikes. All decisions of Producers are at their sole discretion and are final.
Applicant agrees to pay all federal, state and local taxes, including income, use or sales taxes or any other governmental charges imposed on prizes, including the value of any goods or services received and cash gifts, if any, given to applicant or received by applicant by reason of participation in the program and the applicant releases and indemnifies Producer, OCC and DCI from any liability therefore. The applicant also authorizes Producer to deduct or withhold any such taxes or charges that require a payment prior to delivery of said prizes, cash or gifts.
I, the undersigned applicant, have read the above stated Terms and Conditions, Waiver and Release of Liability. By signing this application, I agree to the above stated terms and conditions and agree to release or discharge, indemnify and hold harmless Producers, DCI, Orange County Choppers, known sponsors of the Series or their advertising agencies, any cable service provider of DCI programming, and/or any of their respective employees, officers, directors, representatives, agents, parent, subsidiary, or affiliated companies, licensees, partners or assigns from any and all claims and damages arising from my participation in the Series. Further, I attest that I meet and will meet all of the Eligibility Requirements, and that all of the statements and facts made in this application by me are true and accurate.
I agree to re-execute this form immediately if the Producers request me to do so.
___________________ ____________________________
Dated Name (please print)
___________________ ____________________________
Place Signature
___________________ _____________________________
Social Security Number Address (Street)
_____________________________
(City) (State) (ZIP)
Version: June 6, 2005
--------------------------------------------------------------------------
they named it right,Fantasy,
they want to know everything about ya though,dont think im exceptable.lol
wouldnt even bother myself but thought maybe somebody might want to.
if ya do and ya win
ya owe me a fat bag for pionting this out,
afterall you be on tv and get piad ( have a nice bike)
http://dsc.discovery.com/fansites/amchopper/amchopper.html
--------------------------------------------------------------------------
??American Chopper Fantasy Bike?
Application Form
Part 1: General Info about the American Chopper Fantasy Bike episodes and the Application Process
Four people will be chosen by American Chopper Productions Inc. to participate in the American Chopper Fantasy Bike episodes, get the opportunity to meet Paul Teutul Sr. and Paul Teutul Jr. (??the Teutuls?) while they build your fantasy bike! ??American Chopper? (??Series?) is co-produced by American Chopper Productions Inc. (??Producers?) and Discovery Communications Inc. (??DCI?). The Producers will select the participants to be featured as part of this TV programming at their sole discretion.
Eligibility Requirements:
· You must be at least 21 years old.
You must be a legal U.S. resident.
You must not be a candidate for elected public office, and if selected as a participant, you will not become a candidate for elected public office until 12 months after the initial broadcast of the last episode of the series in which you appear.
You must never have been convicted of a felony and have never had a restraining order or other injunctive relief entered against you. There must not be any outstanding criminal warrants against you.
You must be willing to submit medical information to Producers and submit to a medical examination, psychological examination and background check.
Neither you, nor any of your immediate family members (spouse, ex-spouse, parents, siblings, children, regardless of where they live) and household members (whether related or not) may be or know any employees, officers, directors, representatives or agents of Producers, DCI, Orange County Choppers, known sponsors of the series or their advertising agencies, any cable service provider of DCI programming, and/or any of their respective parent, subsidiary, or affiliated companies, licensees, partners or assigns.
You must be ready to travel at a moment??s notice as determined by Producers at their sole discretion, and be available for approximately three weeks during production of the Fantasy Bike episodes of the series.
The Application Process:
To be chosen to participate in an American Chopper Fantasy Bike episode, you will need to fill out an application and send in a videotape. The main purpose of the video and application is for us to meet you and your family, and to find out about your fantasy bike and why you deserve to be on an episode of American Chopper. The more you tell us, the better!
For the Video:
The Teutuls and OCC will be screening these tapes, so feel free to address them in your video as you tell them your story and explain why they should choose you.
Do you have a compelling story?
Why do you deserve to be on the show?
What would meeting the Teutuls, going to OCC and watching your fantasy bike being built mean to you? How would it affect your life?
Be yourself -- let your personality shine through.
Please know this tape could be used on television, so make sure appearances are fit for TV!
Be creative and have fun!
For the application:
Take the time to answer questions on the application completely and thoroughly.
Don??t be limited by the space allotted on the application! Feel free to continue your answers on a separate sheet if needed.
Your next steps are:
Carefully read, fill out and sign this application with the Terms and Conditions, Waiver and Release of Liability (one per applicant, please).
Send us a three-minute videotape in which you tell us why you should be picked for an American Chopper Fantasy Bike episode. Producers will only consider tapes up to three minutes in length (VHS only, no MiniDV, Hi8 etc., please). Any and all materials submitted to DCI and/or the Producers as part of this application shall become the property of Producers and shall not be returned. The tape may be used as part of the Series or as part of the promotion of the Series.
Mail your application materials by the postmark deadline of July 31, 2005. Producers and DCI reserve the right to extend this deadline at their sole discretion and to change the application in parts or in its entirety.
Again, limit is one application per applicant.
Part 2: Application
Are you nominating yourself? YES NO
Are you nominating someone else? YES NO
If you are nominating someone else, have you spoken with them and are they interested in being nominated? YES NO
If you are nominating someone else, please give us your name and phone number, as well as relationship to the nominee:
Name: Phone Number:
Relationship to nominee:
(The rest of the application is in regards to the nominee.)
Your/Nominee??s First Name: Last Name:
Nickname(s):
Address:
City: State: ZIP:
Phone Number (home): (work):
Fax Number: Cell Phone Number:
Email:
Social Security Number (will be kept confidential):
Gender: M or F
Date of Birth:
Occupation:
Marital Status:
BOYFRIEND or GIRLFRIEND How long? _______________________
MARRIED How long? _______________________
NOT MARRIED, BUT LIVING WITH SIGNIFICANT OTHER How long? ______
SEPARATED How long? _______________________
DIVORCED How long? _______________________
WIDOWED How long? _______________________
Number of children:
Names and ages of children:
Spouse??s name and telephone number:
Siblings?? name(s) and telephone number(s):
Best friend??s name, address and telephone number:
Emergency contact??s name and telephone number:
Are you currently taking medication? Yes (if yes, please list) No
Do you have ongoing health problems? Yes (if yes, please list) No
Do you currently or did you in the past use any drugs, alcohol or are you having any kind of addiction?
Yes (if yes, please list) No
Have you ever been charged with a felony or misdemeanor, other than minor traffic or parking violations?
Yes (if yes, please list) No
Have you ever had a restraining order entered against you or have you been involved in any type of litigation?
Yes (if yes, please list) No
Have you appeared on television before? If so, when and what shows?
Do you belong to any affiliations or organizations?
What are your favorite activities?
What would it mean to you to have your very own American Chopper Fantasy Bike?
Do you have a favorite bike produced on American Chopper? If so, which one and why?
Do you currently own a motorcycle/chopper? If so, how many and what kind(s)?
Have you ever owned a motorcycle/chopper? If so, how many and what kind(s)?
What would it mean to you if you were chosen to participate in a Fantasy Bike episode?
Do you have a favorite memory involving a chopper/motorcycle? If so, explain.
What is your primary motivation for applying for the Fantasy Bike episode (i.e., working with the Teutuls, getting a new bike, being on TV, etc.)?
Tell us why you deserve an American Chopper Fantasy Bike.
Describe your fantasy bike.
If you were chosen, who would be involved in the process with you (i.e., wife, husband, parents, kids, friends, siblings, etc.)?
What qualities do you admire most in others?
How do most people describe you?
Part 3: Terms and Conditions, Waiver and Release of Liability
By submitting an application, each applicant agrees to release, discharge, indemnify and hold harmless Producers, DCI, Orange County Choppers known sponsors of the Series or their advertising agencies, any cable service provider of DCI programming, and/or any of their respective employees, officers, directors, representatives, agents, parent, subsidiary, or affiliated companies, licensees, partners or assigns from any and all claims and damages arising out of his/her participation in the application process or the Series itself.
Applications will only be considered if they are complete. Complete applications consist of the following:
Completed application form (including all of the questions answered and the fully executed Terms and Conditions, Waiver and Release of Liability).
Three-minute videotape labeled clearly with your name, address and contact numbers.
A recent (not older than 6 months, please) photo, stapled to the application form.
Photocopy of a valid U.S. driver??s license.
Social Security number.
Please send applications to: American Chopper Productions, Inc.
13351-D Riverside Drive #437
Sherman Oaks, CA 91423
By signing this application, applicant confirms that he/she is willing to:
Be ready and available to be accepted as a participant and, if selected as a participant, to travel without any prior notice as determined by the Producers and DCI at their sole discretion.
Abide by all applicable U.S. and state laws during the application process and, if selected, during the period in which the Fantasy Bike episodes of the Series are being taped.
Upon signing release forms as may be required by Producers that applicant is aware that all activities in the Series may expose applicant to significant risks and hazards, including death, serious injury, illness and property damage caused by the participation in the Series. Applicant does hereby agree to release, discharge, indemnify and hold harmless Producers, DCI, Orange County Choppers, known sponsors of the Series or their advertising agencies, any cable service provider of DCI programming, and/or any of their respective employees, officers, directors, representatives, agents, parent, subsidiary, or affiliated companies, licensees, partners or assigns from any and all claims and damages arising out of applicant??s participation in the application process or the Series, if applicant injures himself/herself or a third party, or if applicant or a third party suffer any property damage.
Applicant agrees that applicant??s name, voice and likeness may be used in perpetuity as part of the Series or any other program of Producers or DCI, or as part of the advertising, publicity and promotion for the Series, in any and all media now known or hereafter devised.
Applicants must agree to receive all medical exams and immunizations that Producers deem necessary and/or medically appropriate. Applicants must be willing to participate in the Series without any interruption during any time of the year, regardless of personal or religious practices.
Applicant shall be required to sign these Terms and Conditions, Waiver and Release of Liability. If applicant is selected to participate, before applicant can participate in any manner whatsoever with respect to the Series, applicant shall be required to re-execute this document (as amended, if required by Producers at their sole discretion), and to sign a Participant??s Release and a Confidentiality Agreement and any other documents that Producers deem necessary for applicant to participate in the Series (all of which will be furnished to the applicant after being told by Producers that his/her application has been approved). In addition, as part of these Terms and Conditions, Waiver and Release of Liability, applicant must agree among other things, to assume the risk of any and all injury, illness, death, damage, loss, or harm to applicant or applicant??s property, howsoever caused, resulting from or arising out of the selection of applicant, applicant??s participation in the Series, and/or the production and/or exploitation of the Series. By agreeing to the terms of the Confidentiality Agreement, applicant will be required to, among other things, treat all information and material received or acquired in connection with applicant??s participation in the selection process and Series (if selected), including, without limitation, the progress, results and outcome of the Fantasy Bikes, as strictly confidential and shall be strictly required to not disclose any such information to any third party. Without limiting Producers?? right to obtain other relief from applicant, any breach of the Confidentiality Agreement will subject applicant to substantial liquidated damages in accordance with the terms of the Confidentiality Agreement.
If applicant is selected, applicant agrees to authorize Producers to conduct a thorough investigation into applicant??s background and personal history (including, without limitation, applicant??s medical and psychological history).
Applicant must not now be a candidate for public office and must agree not to become one until 12 months after initial broadcast of all episodes of the Series in which applicant appears, if selected as a participant.
Employees, officers, directors, representatives and agents of Producers, DCI, Orange County Choppers, known sponsors of the Series or their advertising agencies, any cable service provider of DCI programming, and/or any of their respective parent, subsidiary, or affiliated companies, licensees, partners or assigns and the immediate family (spouse, ex-spouse, parents, siblings, children, regardless of where they live) or household members (whether related or not) of such employees, officers, directors, representatives and agents or anyone who knows such above listed persons are not eligible to be applicants on the Series or participate in the application process. Furthermore, applicant represents that he/she does not know anyone at the above-mentioned companies.
Due to the high volume of applications, Producer cannot respond to every applicant who applies to appear on the Series.
Producers reserve the right to stop applicant??s participation in the Series at any time for any reason, including but not limited to health, safety, legal and other reasons at their sole discretion, with no further liability to applicant. Applicant agrees to accommodate production needs as it relates to technical requirements, scheduling changes, production requirements, etc. as deemed necessary by Producers at their sole discretion. Producers reserve the right to change or amend this application at their sole discretion. All decisions of Producers are final and at their sole discretion.
Producers shall not be liable for any problems or delays with respect to, but not limited to, acts of god, war, riots, travel delays, human, technical, mechanical or electronic malfunctions or any individual??s inability to apply or participate in the Series. Producers reserve the right to decide whether to continue the realization of a Fantasy Bike and to change, alter or add to a Fantasy Bike, at their sole discretion.
The selection of the applicants will be made by the DCI, Producers and the Teutuls based on such criteria as DCI, Producers and the Teutuls shall solely determine which criteria may be highly subjective. DCI, Producers and the Teutuls are not obligated to select anyone, even if someone meets all eligibility requirements and all criteria for selection. Producers??, DCI??s and the Teutuls?? decisions regarding the number and selection of applicants are final and not subject to challenge or appeal. Producers also reserve the right to change the format of the Series, to change the application process, the rules and process of the participation, and the elements of the actual Fantasy Bikes. All decisions of Producers are at their sole discretion and are final.
Applicant agrees to pay all federal, state and local taxes, including income, use or sales taxes or any other governmental charges imposed on prizes, including the value of any goods or services received and cash gifts, if any, given to applicant or received by applicant by reason of participation in the program and the applicant releases and indemnifies Producer, OCC and DCI from any liability therefore. The applicant also authorizes Producer to deduct or withhold any such taxes or charges that require a payment prior to delivery of said prizes, cash or gifts.
I, the undersigned applicant, have read the above stated Terms and Conditions, Waiver and Release of Liability. By signing this application, I agree to the above stated terms and conditions and agree to release or discharge, indemnify and hold harmless Producers, DCI, Orange County Choppers, known sponsors of the Series or their advertising agencies, any cable service provider of DCI programming, and/or any of their respective employees, officers, directors, representatives, agents, parent, subsidiary, or affiliated companies, licensees, partners or assigns from any and all claims and damages arising from my participation in the Series. Further, I attest that I meet and will meet all of the Eligibility Requirements, and that all of the statements and facts made in this application by me are true and accurate.
I agree to re-execute this form immediately if the Producers request me to do so.
___________________ ____________________________
Dated Name (please print)
___________________ ____________________________
Place Signature
___________________ _____________________________
Social Security Number Address (Street)
_____________________________
(City) (State) (ZIP)
Version: June 6, 2005
--------------------------------------------------------------------------