Title: Surname: First Name

TITLE: SURNAME: FIRST NAME:
ADDRESS:
AGE & DATE OF BIRTH:
OCCUPATION
CONTACT NUMBERS
Home / Work / Mobile
EDUCATIONAL BACKGROUND, QUALIFICATIONS ETC.
CAREER HISTORY (last 10 years only)
HISTORY OF QUIZZES
A. Have you ever had an audition for a TV quiz before? If so please state:
B. Prestigious quizzes entered/won, broadcast appearances, subjects chosen and dates e.t.c.
C. If you have appeared on BBC Television or Radio Mastermind, or Discovery Mastermind, you are contractually required to inform us. Please state when you appeared (year), what your specialist subjects were, and how far you got:
HOBBIES AND SPECIAL INTERESTS:
WHY DO YOU WANT TO APPEAR ON THIS QUIZ?
ANY OTHER INFORMATION ABOUT YOURSELF WHICH YOU FEEL MAY BE RELEVANT TO YOUR APPLICATION:
CHOICE OF SPECIALIST SUBJECT 1
If you are picked to participate in the series you will be asked to nominate specialist subjects. Please provide 4 subjects upon which you would like to answer questions.
SUBJECT:
LIST YOUR MAIN READING ON THE SUBJECT: (give authors/publishers)
This is VITAL so that we can ascertain what you understand your subject to be
CHOICE OF SPECIALIST SUBJECT 2
SUBJECT:
LIST YOUR MAIN READING ON THE SUBJECT: (give authors/publishers)
This is VITAL so that we can ascertain what you understand your subject to be
CHOICE OF SPECIALIST SUBJECT 3
SUBJECT:
LIST YOUR MAIN READING ON THE SUBJECT: (give authors/publishers)
This is VITAL so that we can ascertain what you understand your subject to be
CHOICE OF SPECIALIST SUBJECT 4
SUBJECT:
LIST YOUR MAIN READING ON THE SUBJECT: (give authors/publishers)
This is VITAL so that we can ascertain what you understand your subject to be
LOCATION OF AUDITIONS
They are likely to be held in a number of different locations around the UK and may include…
Belfast, Birmingham, Bristol, Cardiff, Newcastle, Leeds, Edinburgh, Glasgow, Oxford, London, Cambridge or Manchester.
Which would be the best location for you? If none of these are suitable then please suggest another location.
CONTESTANT’S AVAILABILITY
Recordings take place in Manchester. Should you be successful in being selected for the series, you may be required to attend up to 4 recording days which could include weekdays. (Note: we will do our best to accommodate you, but please be aware that it may not be possible to include you in the series if your availability is limited.)
Please indicate dates in 2012 you will definitely not be available:
MONITORING
The BBC is committed to equal opportunities for all, irrespective of race, colour, creed, ethnic or national origins, gender, marital status, sexuality, disability or age.
Note: The BBC will only use your personal details for the purpose of selecting contestants for the Mastermind series. Your information, in particular your ethnic origin and disability data, will also be used for statistical monitoring of Mastermind's applicants. Your information will be treated in the strictest confidence by the BBC and will not be provided to any other party. For further information, please read the BBC's privacy policy at www.bbc.co.uk/privacy/
ETHNIC ORIGIN
  ASIAN/ASIAN BRITISH
  BLACK/BLACK BRITISH
  CHINESE
  MIDDLE/NEAR EASTERN
  MIXED ETHNIC GROUP
  WHITE
  BLACK OTHER ______
GENDER / DISABILITY
  MALE
  FEMALE / Do you consider yourself to have a disability?
  YES
  NO
ADVERTISING
To help us with our research would you please state where you found out about the application process for Mastermind (please tick as appropriate):
  TV APPEAL
  RADIO (Please state name of station) ______
  PRESS ADVERT (Please state publication) ______
  FLYER OR POSTER (Where did you see it?)______
  BBC WEBSITE
  EMAIL
  WORD OF MOUTH
  OTHER (Please specify)______
SIGNATURE
Please note: You may be contacted in the future regarding subsequent series of Mastermind.
I confirm that the information supplied by me on this form is correct.
Signature Date
We regret that BBC members of staff and their immediate families are not eligible to apply.
Please return (with photo attached) to:
Mastermind (Returns),
5th Floor, Bridge House, Salford, M50 2BH