PLEASE ATTACH EITHER
A RECENT PHOTO OF
EACH MEMBER OF YOUR
TEAM OR A TEAM
PHOTO
EGGHEADS TEAM CONTESTANT APPLICATION FORM
You are applying for you and your team (individually and collectively referred to as “you”, “your” throughout this form) to be
considered as contestants for any future series of the programme provisionally entitled “Eggheads” (the “Programme”) which
12 Yard Productions (“12 Yard”) intends to but does not undertake to produce for initial transmission on the BBC (the
“Commissioning Broadcaster).
PLEASE READ THIS APPLICATION FORM VERY CAREFULY BEFORE COMPLETING AND SIGNING.
You hereby undertake that the information you give in this application form is correct. If any of the information you provide in
this application form becomes incorrect between the date of this application form and the date of 12 Yard’s decision as to
whether you have been selected to go forward to the next stage of the selection process, you agree to immediately inform 12
Yard of the nature of such change. You hereby acknowledge that in the event 12 Yard selects you to appear in the Programme
and you have given false information on this application form, then 12 Yard shall be entitled to withdraw your participation in
the Programme.
DATA PROTECTION
Your application will be sent to 12 Yard and 12 Yard may share your information with the broadcaster of the Programme. 12
Yard and the broadcaster will use your personal details only for the purposes of considering your application, for
administration and for related services should you be successful. Your personal information will not be passed to anyone else,
except where required to do so, then 12 Yard may pass on your personal information to a regulator or governmental authority
including the Information Commissioner, OFCOM, and PhonepayPlus. Your personal information will be kept securely and in
accordance with the Data Protection Act 1998 and other applicable privacy legislation.
TEAM MEMBER DETAILS
Team Member 1
Full Name:
Age (NB: Applicants must be aged 18
or over):
D.O.B:
Address:
Home Tel:
Mob:
Work Tel:
E-mail:
Residency status (NB: Applicants must
be resident and be currently living in
the United Kingdom)
What is your present occupation?
What is your strongest subject?
What is your weakest subject?
Have you applied for or appeared on any
other television shows? (If yes, please list
all television appearances (completed and
pending (as is applicable)) and give details,
i.e. name of show, broadcast date, channel
and any prizes won – all as is applicable)
Do you consider yourself to be
physically fit?
Do you have any medical conditions
that the production team should be
made aware of?
If you have answered “yes” to the
above question please specify details.
Do you consider yourself to have a
disability?
Yes / No
Yes / No
Yes / No
If you have answered “yes” to the above
question please specify details below and
any special requirements you may have
1
for any audition or studio appearance):
Team Member 2
Full Name:
Age (NB: Applicants must be aged 18
or over):
D.O.B:
Address:
Home Tel:
Mob:
Work Tel:
E-mail:
Residency status (NB: Applicants must
be resident and be currently living in
the United Kingdom)
What is your present occupation?
What is your strongest subject?
What is your weakest subject?
Have you applied for or appeared on any
other television shows? (If yes, please list
all television appearances (completed and
pending (as is applicable)) and give details,
i.e. name of show, broadcast date, channel
and any prizes won – all as is applicable)
Do you consider yourself to be
physically fit?
Do you have any medical conditions
that the production team should be
made aware of?
If you have answered “yes” to the
above question please specify details.
Do you consider yourself to have a
disability?
Yes / No
Yes / No
Yes / No
If you have answered “yes” to the above
question please specify details below and
any special requirements you may have
for any audition or studio appearance):
Team Member 3
Full Name:
Age (NB: Applicants must be aged 18
or over):
D.O.B:
Address:
Home Tel:
Mob:
Work Tel:
E-mail:
Residency status (NB: Applicants must
be resident and be currently living in
the United Kingdom)
What is your present occupation?
What is your strongest subject?
What is your weakest subject?
Have you applied for or appeared on any
other television shows? (If yes, please list
all television appearances (completed and
pending (as is applicable)) and give details,
i.e. name of show, broadcast date, channel
and any prizes won – all as is applicable)
Do you consider yourself to be
physically fit?
Do you have any medical conditions
that the production team should be
made aware of?
If you have answered “yes” to the
Yes / No
Yes / No
2
above question please specify details.
Do you consider yourself to have a
disability?
Yes / No
If you have answered “yes” to the above
question please specify details below and
any special requirements you may have
for any audition or studio appearance):
Team Member 4
Full Name:
Age (NB: Applicants must be aged 18
or over):
D.O.B:
Address:
Home Tel:
Mob:
Work Tel:
E-mail:
Residency status (NB: Applicants must
be resident and be currently living in
the United Kingdom)
What is your present occupation?
What is your strongest subject?
What is your weakest subject?
Have you applied for or appeared on any
other television shows? (If yes, please list
all television appearances (completed and
pending (as is applicable)) and give details,
i.e. name of show, broadcast date, channel
and any prizes won – all as is applicable)
Do you consider yourself to be
physically fit?
Do you have any medical conditions
that the production team should be
made aware of?
If you have answered “yes” to the
above question please specify details.
Do you consider yourself to have a
disability?
Yes / No
Yes / No
Yes / No
If you have answered “yes” to the above
question please specify details below and
any special requirements you may have
for any audition or studio appearance):
Team Member 5
Full Name:
Age (NB: Applicants must be aged 18
or over):
D.O.B:
Address:
Home Tel:
Mob:
Work Tel:
E-mail:
Residency status (NB: Applicants must
be resident and be currently living in
the United Kingdom)
What is your present occupation?
What is your strongest subject?
What is your weakest subject?
Have you applied for or appeared on any
other television shows? (If yes, please list
all television appearances (completed and
pending (as is applicable)) and give details,
i.e. name of show, broadcast date, channel
and any prizes won – all as is applicable)
Do you consider yourself to be
Yes / No
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physically fit?
Do you have any medical conditions
that the production team should be
made aware of?
If you have answered “yes” to the
above question please specify details.
Do you consider yourself to have a
disability?
Yes / No
Yes / No
If you have answered “yes” to the above
question please specify details below and
any special requirements you may have
for any audition or studio appearance):
Team Member 6
Full Name:
Age (NB: Applicants must be aged 18
or over):
D.O.B:
Address:
Home Tel:
Mob:
Work Tel:
E-mail:
Residency status (NB: Applicants must
be resident and be currently living in
the United Kingdom)
What is your present occupation?
What is your strongest subject?
What is your weakest subject?
Have you applied for or appeared on any
other television shows? (If yes, please list
all television appearances (completed and
pending (as is applicable)) and give details,
i.e. name of show, broadcast date, channel
and any prizes won – all as is applicable)
Do you consider yourself to be
physically fit?
Do you have any medical conditions
that the production team should be
made aware of?
If you have answered “yes” to the
above question please specify details.
Do you consider yourself to have a
disability?
Yes / No
Yes / No
Yes / No
If you have answered “yes” to the above
question please specify details below and
any special requirements you may have
for any audition or studio appearance):
ABOUT YOUR TEAM
Has your team ever won anything? If
so, what have you won and how?
How did your team originally meet?
What are your strongest subjects as a
team?
What are your weakest subjects as a
team?
How did you hear about the show?
AUDITIONS
If your team was to be
invited to an audition
which one of the
following cities would be
preferable?
LONDON [ ]
BRISTOL [ ]
BIRMINGHAM [ ]
BELFAST [ ]
PENZANCE [ ]
BRIGHTON [ ]
NORWICH [ ]
CARDIFF [ ]
EDINBURGH [ ]
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LIVERPOOL [ ]
PLYMOUTH [ ]
MANCHESTER [ ]
NEWCASTLE [ ]
LEEDS [ ]
PORTSMOUTH [ ]
Please note for that for applicants based on the Isles we are able to visit in special cases providing 12
Yard can get enough teams together for an audition. Please write in the name of the Island in which
you and you team resides here:
……………………………………………………………………………….
PLEASE NOTE: 12 Yard and the commissioning broadcaster of the Programme are committed to equal
opportunities to all, irrespective of disability or medical condition. This data will also be treated in the strictest
confidence by 12 Yard and the commissioning broadcaster and will not be provided to any other party.
Other than spent convictions under the Rehabilitation of Offenders Act 1974, please disclose in writing
full details of any and all criminal convictions, criminal charges and/or criminal proceedings of any kind
whatsoever from any country. For the purposes of this application a criminal conviction shall include any
unspent convictions, initial plea, verdict or finding of guilt, plea of no contest, or pronouncement of
sentence by a trial court, even if that conviction may not be final or sentence actually imposed, until
appeals are exhausted.
PLEASE NOTE: That if you progress further in the application process, 12 Yard reserves the right to carry out
background checks on you to verify this information.
MEMBER 1
MEMBER 2
MEMBER 3
MEMBER 4
MEMBER 5
MEMBER 6
TERMS AND CONDITIONS
To be considered for the Programme please return your completed application form including a photo of each member of your
team or a team photo by 25th December 2010 (the “Closing Date”) by e-mail to: [email protected] or alternatively
post your completed application form, along with a photo of each member of your team or a team photo, to: EGGHEADS
APPLICATIONS, 12 YARD PRODUCTIONS, 131-151 GREAT TITCHFIELD STREET, LONDON, W1W 5BB
There will be no charge for submitting your application by e-mail, although internet service provider charges may apply. You
will be responsible for paying all postage charges should you decide to submit your application by post.
Due to the large number of applications we receive we will not acknowledge or respond to each application but only to those
of successful applicants. The Programme production team will review your application and shall decide which application is
suitable to be put forward to the next stage of the selection process. The decision of the Programme production team is final.
Any and all costs of completing and sending in your application and, if you are selected, any transport costs to and from the
auditions, shall be solely borne by you, and 12 Yard shall not refund any such costs unless otherwise agreed in writing with 12
Yard.
12 Yard cannot guarantee that your application will be successful and the choice of applicants to proceed to the next stages and
beyond for the Programme will be at the Programme production team’s selection and discretion at the application stage. There
will be no right of appeal against any decisions taken.
12 Yard and their subcontractors do not accept any responsibility whatsoever for any technical failure or malfunction or any
other problem with any computer network, system, server, provider or otherwise or any postal service failures which may
result in any application not being properly received.
Application forms which are sent after the Closing Date or those which are incorrect, false, misleading, incomplete, and
incomprehensible, incorrectly addressed, lost in transit, or with insufficient postage, or not received by 12 Yard at the relevant
postal or email address will not be considered. 12 Yard cannot accept responsibility for any application forms which are not
received by the closing date.
12 Yard’s decision is final and we reserve the right to refuse any submitted application.
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12 Yard would also like to state at this stage that receiving an application form, and/or a phone call from a member of the
production team DOES NOT automatically mean that you will be appearing on the Programme and 12 Yard reserves the right
at any time to stand down an applicant, even if you have been given a date to attend auditions.
12 Yard does not represent, undertake or warrant that it will broadcast any episode of the Programme which may or may not
include an applicant’s participation.
You further undertake, warrant and agree;
(a)
not to discuss any information concerning 12 Yard, the Programme or your possible participation in it, with any
other person or company, whether by means of discussion, letter, press and television interviews or otherwise,
without the prior written consent of 12 Yard; and
(b)
to the photographic materials supplied as part of this application being featured in the Programme in perpetuity by
all means and in all media now known or hereafter invented; and
(c)
that the information supplied on this application form as well as all other information that you otherwise submit to
12 Yard is entirely honest and truthful and that you are not deceiving 12 Yard about your identity or in any other
way; and
(d)
that you are aged eighteen (18) years or older and be legally resident and currently living in the United Kingdom;
and
(e)
the photographic images submitted as part of this application will only be accepted if they are solely your original
work and they include no third party images or other third party content and warrant that you will not submit any
material which in any way infringes the rights of a third party, or which infringes any applicable laws or are in any
way harmful; and
(f)
(g)
(h)
to the processing of your personal data as described above; and
(i)
that you shall notify 12 Yard immediately if there are any criminal charges and/or convictions brought against you
from the date of this application form up to and including the date of transmission of the Programme; and
(j)
to provide to 12 Yard any documentation requested by it for the purposes of verifying the information that you
have provided to 12 Yard in this application form or otherwise (including providing all consents and assistance in
carrying out any police background searches if required by 12 Yard).
to paying your own postage costs if sending this application form by post; and
that if you are successful in reaching the auditions, that you may be filmed by 12 Yard and accept that your
appearance may be included in the Programme; and
The information you have provided will be contained in a secure and private database. If you do not wish to have your details
entered into this database please tick this box. 
If you have not ticked the above box and you would like to be considered for any other 12 Yard shows please tick this box 
By returning this application form you confirm that the information provided within it is, to the best of your knowledge, true
and accurate and that you have read and understood the above terms and conditions. IF YOU ARE RETURNING THIS
FORM BY E-MAIL THEN BY PRINTING YOUR NAME YOU ARE AGREEING TO THE ABOVE TERMS AND
IF YOU ARE ASKED TO ATTEND AN AUDITION WE WILL ASK YOU TO SIGN THIS FORM IN PERSON.
TEAM MEMBER 1
TEAM MEMBER 2
Signature: (if emailing form type in name)
Signature: (if emailing form type in name)
___________________________________________
Date:
___________________________________________
Date:
___________________________________________
Print name:
___________________________________________
Print name:
___________________________________________
___________________________________________
TEAM MEMBER 3
TEAM MEMBER 4
Signature: (if emailing form type in name)
Signature: (if emailing form type in name)
___________________________________________
Date:
___________________________________________
Date:
___________________________________________
Print name:
___________________________________________
Print name:
___________________________________________
___________________________________________
TEAM MEMBER 5
TEAM MEMBER 6
Signature: (if emailing form type in name)
Signature: (if emailing form type in name)
___________________________________________
Date:
___________________________________________
Date:
___________________________________________
Print name:
___________________________________________
Print name:
___________________________________________
___________________________________________
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Remember, please complete this form and send it back to us with a recent photograph of each of your team or
a team photograph
via email to: [email protected]
or send by post with a recent photograph of each of your team or a team photograph to:
EGGHEADS APPLICATIONS, 12 YARD PRODUCTIONS, 131-151 GREAT TITCHFIELD STREET,
LONDON, W1W 5BB
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