The Millionaire Matchmaker Dater App - Season 8
ELECTRONIC APPLICATION INSTRUCTIONS:
1. DO NOT USE AN IPAD OR IPHONE TO FILL THE APPLICATION OUT. It will not save and you will lose all of your work. To fill out this application electronically, please submit from a desktop or laptop computer.
2. You must fill out the entire application. Do not leave any question unanswered. If any question is not applicable to you, write N/A in the space provided, or if no space is provided, next to the question. Failure to answer any question may be grounds for not considering your application.
3. Complete and submit this application ASAP, as we have a very limited amount of time until production begins. That said, PLEASE, take your time and answer completely and honestly.
PLEASE SEND ANY QUESTIONS REGARDING THIS APPLICATION TO email@example.com
Thank you for your time and effort and GOOD LUCK!
To be considered for this show, you must fill out this application honestly, accurately, completely, and to the best of your ability. Failure to do so may result in your elimination from consideration or from the show, as well as the forfeiture of any things you may have received, whether or not you have already received them. Applications that are incomplete, illegible, or corrupted are void and may not be accepted.
Note: Throughout this application, you will be asked for contact information for various people. By listing a person, you are granting us permission to contact that person as a reference, as a means of contacting you, or as a means of obtaining additional information about you.
**NOTE** IF YOUR FORM WON'T ALLOW YOU TO SUBMIT, IT MEANS YOUR ANSWERS WERE TOO LONG OR PHOTOS ARE TOO BIG. PLEASE SHORTEN YOUR ANSWERS AND RESUBMIT.
Do you live in the Southern California or Northern California area?
Cell Phone Number
Address Line 2
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Bosnia and Herzegovina
British Indian Ocean Territory
Central African Republic
Democratic Republic of the Congo
Republic of the Congo
Papua New Guinea
Saint Kitts and Nevis
Saint Vincent and the Grenadines
Sao Tome and Principe
Trinidad and Tobago
United Arab Emirates
United States Minor Outlying Islands
Virgin Islands, British
Virgin Islands, U.S.
Do you have an audition with one of our casting directors for "The Millionaire Matchmaker" (the "Program") scheduled?
Please list your Facebook Profile link.
Please list your Instagram Name.
Height: __________ Weight: __________ Eye Color: __________ Hair Color: ________
When is your birthday and what is your Zodiac Sign?
Have you ever been on the Program in the past? If so, did you go on a “master date”?
Where did you hear about our casting?
PART I: GETTING TO KNOW YOU (Please answer every question. Do not leave any questions unanswered or any space blank. If a question is not applicable to you, write N/A in the space provided.)
Have you ever been a member of the Millionaire’s Club or any other dating services? If Yes, which one and when?
Do you have any millionaire friends who might be interested in being on the show?
Do you prefer to date men, women or both?
Have you ever been engaged or married? If Yes, when did it end?
Do you have any kids? If not, do you want to have kids?
What are your views on marriage?
What’s the longest relationship you’ve been in?
When did your last relationship end and why?
Something I learned from my past relationships: ___________________________________
Do you have a “type” that you usually date or look for? If Yes, describe:
List some of your celebrity crushes.
Describe your ideal mate and some of the qualities you look for.
What’s your “deal-breaker” quality in a man/woman (based on your dating preference)?
What makes you a great catch? Why would Patti choose you as the best candidate for one of her most prestigious millionaires? (don't be shy...tell us about your accomplishments, talents, skills, anything you're proud of.)
“Most people I’ve dated say I’m too ______________________.”
What kind of a girlfriend/wife or boyfriend/husband would you be? How do you take care of your mate?
What are your future goals and aspirations?
Please list highest level of education and if college or junior college, any degrees or certificates earned and the name of the college/university where such degrees/certificates were earned:
Do you have any daily rituals/habits? (religious, health conscious, etc)
What do you like to do for fun? List some of your hobbies.
"THIS OR THAT"
Choose which one of the two options best fits you
Books or Movies?
Vegas or Hawaii?
Cooking or Dining out?
Beach or Snow?
Museums or Clubbing?
Passive or Aggressive?
Traveling or cuddling on the couch?
Politics or E! News?
Laughing or Meaningful conversation?
Hiking or Happy Hour?
Save or Spend?
Sports or Shopping?
PART II: THINGS WE MUST ASK (Please answer every question. Do not leave any questions unanswered or any space blank. If a question is not applicable to you, write N/A in the space provided.)
Are you a legal resident of the United States?
Have you applied to be on any TV shows in the past year? If yes, which one(s)?
Are you currently being considered for any other reality shows, including, without limitation, any game or contest shows? If YES, which one(s)?
Will you be appearing on any TV shows that are scheduled to air in the next year? If YES, which one(s)?
Have you ever acted, performed or appeared on television (including cable), film or stage?
If YES, please list the dates and shows:
Are you or have you ever been a member of the television/film unions SAG or AFTRA? If YES, please provide dates and details.
Do you know anyone else who is applying to be on “THE MILLIONAIRE MATCHMAKER”
(the “Program”)? If YES, please list their name(s) and address(es):
Not including your current residence, list the cities and countries you have lived in and state how long you lived in each place?
Have you ever been in the military? If YES, please list branch of Military, Dates of Service, AND Type of discharge.
(If YES, you will need to complete a form authorizing disclosure of your military records, including, without limitation, discharge papers, to the producers of the Program and please email a copy of your DD214 or any other discharge documentation.)
Were you ever the subject of any disciplinary proceedings or actions in the military? If YES, please describe in detail, including, without limitation, date(s), place(s), nature of charge(s), outcome of proceedings and any actions taken.
Have you ever been convicted of a felony or a misdemeanor? If YES, please give dates and details:
Have you ever been a party to a civil lawsuit? If YES, please describe when and where the event occurred, the other party (ies) to the lawsuit, whether you were the plaintiff or defendant, the nature of the case, and what the outcome was:
Have you ever had a temporary restraining order issued against you or has anyone ever attempted to obtain a temporary restraining order against you?
If YES, please give details, including, without limitation, date(s), place(s), name of party seeking the temporary restraining order and relationship of such party to you, and a description of the basis upon which the temporary restraining order was sought, whether it was issued, and the basis upon which it was issued.
Have you ever been convicted of any crime of reckless or drunk driving? If YES, please describe in detail, tell us when and where the event occurred, and what the outcome was.
Have you ever done or been involved in anything that would cause the Program producers and/or the cable network and affiliates that may exhibit the Program any embarrassment or monetary loss if you are chosen to participate in the Program? If YES, please list and explain the specific matters:
If you are chosen to be on the Program, is there any person or part of your life that you would prefer not to share on-camera (i.e., social organizations, activities, friends, family)? If YES, please describe, including your reasons:
Have you appeared in any magazines, publicly disseminated photographs, advertisements or on the Internet? If YES, please describe:
Have you ever created a website or posted any materials on any website? If YES, name and describe the website you created and/or the materials you posted.
Is there anyone among your family, friends or work colleagues that would object to you appearing on television? If YES, please identify all such persons, including your relationship with them and the reason they would object.
PART III: REFERENCES AND CONTACTS (Please answer every question. Do not leave any questions unanswered or any space blank.) Please remember to only list people in this section who you give us permission to contact as references or as a means to contact you.
Please list three people whom you frequently see in case we need to get in touch with you on very short notice or who can serve as a reference (i.e., significant other, roommate, boss, etc.): PLEASE INCLUDE NAME, ADDRESS, PHONE AND HOW YOU KNOW THEM
Please list three people who are not related to you and who have known you for over 3 years: PLEASE INCLUDE NAME, ADDRESS, PHONE AND HOW YOU KNOW THEM
Please attach a HEADSHOT of yourself.
Please attach a FULL BODY SHOT of yourself.
PART IV: ELIGIBILITY REQUIREMENTS AND RELEASES
1) You must have in full force and effect beginning no later than May27th, 2014 and continuing through the end of 2014 any necessary or appropriate visa(s) or waiver(s) to enable you to legally participate in the Program in the U.S.
2) You must be at least 21 years of age as of May 27th, 2014.
3) You must be single.
4) You must be able to be in Los Angeles, CA for a specific length of time to be designated by Producer.
5) You must not be a candidate for public office and must agree not to become one for at least one (1) year following the initial exhibition of the episodes of the Program in which you appear, if selected as a participant.
6) Green Bottle Pictures, Inc. (“Producer”) and NBCUniversal (as defined below) reserve the right to render ineligible any person who either of them determines, in the sole discretion of either of them, is sufficiently connected with the production, administration, judging, or distribution of the Program, such that his/her participation in the Program could create the appearance of impropriety. In making this decision, Producer and NBCUniversal may consider whether you know or have known anyone who is or has been within the last two (2) years an employee, officer, director or agent of any of the following:
(i) Producer or any other person or entity involved in the development, production, distribution or other exploitation of the Program or any variation thereof;
(ii) NBCUniversal Television Group or any of its parent, subsidiary or affiliated entities, including, without limitation, NBCUniversal Media, LLC, it’s broadcast networks and studios, cable networks (including Bravo Media LLC) and any studios, film businesses, digital businesses, parks and resorts (collectively, “NBCUNIVERSAL”) (for more information about NBCUniversal businesses, please visit http://corporate.comcast.com or http://www.nbcuni.com);
(iii) Any sponsor of the Program or its advertising agency; or
(iv) Any person or entity supplying goods, services or prizes (as applicable) to the Program. Please list any such relationships here; if none, write “None”
7) If you are selected as a potential participant, you must execute waivers and release agreements, including, but not limited to, an Appearance Release Form and Arbitration Provision and other agreement(s) as required by the Producer or NBCUniversal, or any of their licensees, successors or assigns.
8) You will need to be available to the production during a time between MAY 27TH, 2014 – September 12th, 2014 the specific month(s) and dates to be designated by Producer and are subject to change at Producer’s sole discretion) and be willing to travel to various locations as part of production.
9) You hereby give the following representations, warranties, acknowledgements, consents and releases:
______(a) By signing below, I hereby represent, warrant, acknowledge and agree that: (i) I have read and I meet and agree to be bound by the eligibility requirements set forth in this application; (ii) I have completed this application honestly and accurately; (iii) if any of the information in this application is found to be false or incomplete, this will be grounds for dismissal from the participant selection process and/or from the Program if selected; (iv) even if I meet the eligibility requirements, Producer has no obligation to further contact me, to interview me and/or select me as a participant; (v) I agree to keep strictly confidential all information about the Program that I acquire during the participant selection process and/or during my participation in the Program (if applicable); (vi) my voice, actions, and likeness will be recorded as a part of this application and participant selection process, and I understand that Producer may, but is in no way obligated to, actually use such recordings within the Program or in any other manner; (vii) even if I am selected as a participant, Producer has no obligation to produce the Program and NBCUniversal has no obligation to exhibit it, even if produced; (viii) all decisions by Producer concerning selection of the participants are final and not subject to challenge or appeal; and (ix) Producer has no obligation to return any materials submitted by me as part of the participant selection process, if any, whether or not I am selected as a participant, and Producer may, but is in no way obligated to, use any such materials in the Program or in any other manner.
______(b) By submitting this application, I hereby consent to the recording, use and reuse by Producer, NBCUniversal, and any of their respective licensees, successors, assignees, parents, subsidiaries, or affiliated entities, and each of their respective employees, agents, representative, officers and directors (collectively “Releasees”) of my voice, actions, likeness, name, appearance, biographical material, and any information contained in, derived from or obtained in connection with my application to be a participant in the Program or in any materials submitted by me in connection with my application (collectively “Likeness”), as edited, altered, or modified by the Producer or by any of the other Releasees, in any and all media now known or hereafter devised, worldwide in perpetuity, in or in connection with the Program or any other work. I agree that the Releasees or any of them 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 the Releasees exclusively own all right, title, and interest (including, without limitation, all copyrights) in and to any and all recordings made by
them and in and to any and all video that I have provided in connection with my application and any other materials that I have provided or may provide in connection with my application or the Program (collectively, the “Materials”), including, without limitation, the right to edit, alter or modify the Materials and to use all or part of the Materials and my Likeness in any and all media now known or hereafter devised worldwide, in perpetuity. Without in any way limiting the foregoing, if I perform or include any music (other than music supplied to me by Producer) in connection with my application or the Program, I represent and warrant that I own all rights to such music, and I grant Producer the right to
record, reproduce and publicly perform any such music in and in connection with the Program or any other work. Without in any way limiting the waivers and releases set forth herein, I waive any claims to royalties of any kind, whether accruing now or in the future, from Producer and NBCUniversal for the use of any such music, including, without limitation, any applicable copyright, public performance, mechanical and synchronization royalties. I further agree that Releasees may use my Likeness and the Materials in connection with any promotion, publicity, marketing or advertisement. I grant the rights hereunder whether or not I am selected to participate in the Program in any manner whatsoever. I understand that I will not be paid any money for giving Releasees these rights or for signing this application.
I agree to take, at Producer’s expense, any further action, in writing (including, without limitation, execution of affidavits and/or other documents), requested by Producer to effect, perfect or confirm Producer’s and NBCUniversal’s rights in the Materials and my Likeness, including, without limitation, the rights to use, modify, reproduce, publish, perform, display, distribute, make derivate works of and otherwise commercially and non-commercially exploit the Materials and my Likeness in perpetuity and throughout the universe, in any manner or medium now existing or hereafter developed, without separate compensation to me or any other person or entity.
_____(c) I understand that the participant selection process will involve subjective decisions made by certain individuals selected by Producer and/or NBCUniversal in their sole discretion. I further understand that those certain individuals, NBCUniversal, Producer and/or other persons or entities may be acquainted with or have some familiarity with some or all of the applicants to varying degrees. I understand and agree that all participant selection and elimination decisions shall be final and binding on me in all respects, and shall not be subject to challenge or appeal.
_____(d) I hereby authorize Producer and any person or entity designated by Producer to investigate, access and collect information about me, about any of the statements made by me in this application, any supporting documents and any other document that I submit, have signed or provided or do sign or provide in connection with my application to be selected as a participant in the Program, or any other written or oral statements I make in connection therewith. Without limiting the foregoing, I irrevocably authorize Producer and any person or entity designated by Producer to secure information about me and my experiences from my current and former employers, associates, friends, family members, educational institutions, government agencies, credit reporting agencies, any branch of the military and any references I have provided, and I irrevocably authorize such parties to provide information concerning me. I hereby unconditionally and irrevocably release and forever discharge Producer, the persons or entities designated by Producer and all such parties and persons from any and all claims, actions, damages and liabilities arising out of or in connection with any such investigation. I specifically authorize investigation of my employment records, medical records, and government records, including, but not limited to, my motor vehicle records, criminal records, civil records, military records, credit and consumer report(s). I acknowledge and agree that any such information obtained by Producer or by any person or entity designated by Producer pursuant to this paragraph or otherwise may be used for purposes of selecting participants in the Program or in the course of producing the Program, and may be described or otherwise related in and in connection with the Program, in and in connection with another program, and in and in connection with any advertising, promotion or publicity for the Program or other program.
10) RELEASE AND AGREEMENT NOT TO SUE. To the maximum extent permitted by law, I release Releasees from any and all liability arising out of my participation in or in connection with the Program, including, without limitation, the recording of my Likeness and the Materials, my participation in the participant selection process of the Program, and any exploitation of the Program, my Likeness or the Materials, on any legal theory whatsoever (including, without limitation, personal injury, rights of privacy and publicity, false light and defamation) (the “Released Claims”). Further, to the maximum extent permitted by law, I agree not to sue Releasees as a result of the recording or use of my Likeness or the Materials (including, without limitation, any claim that such use defames me or invades any right of privacy and/or publicity) or for any reason based on any of the Released Claims hereunder.
11) CONFIDENTIALITY. Whether or not I am selected to be a participant on the Program, I shall keep in strictest confidence and shall not disclose to any other applicant, participant or other third party at any time (i.e., prior to, during, or after the taping or exhibition of
any episode of the Program) any information or materials of any kind, including without limitation, any information or materials concerning or relating to Producer or to NBCUniversal, the business of Producer or NBCUniversal, any program produced by Producer or exhibited by NBCUniversal, including, without limitation, any information concerning or relating to the Program, the Program applicants, the Program participants, the location(s) of the Program, the events contained in the Program, or the outcome of any episode of the Program, that I read, hear or otherwise acquire or learn in connection with
or as a result of my applying to be a participant on the Program or (if I am selected to be a participant) as the result of my experiences as a participant on the Program (collectively, the “Information and Materials”). I acknowledge and agree that the Information and Materials are confidential and the exclusive property of Producer or NBCUniversal. At no time will I ever, directly or indirectly, divulge in any manner or use or permit others to use any of the Information and Materials. I acknowledge and agree that my obligations with respect to confidentiality set forth in this application shall continue in perpetuity or until terminated by NBCUniversal by giving me written notice of termination. In no event will I have the right to terminate my confidentiality obligations under this application. I acknowledge that in the event I breach the confidentiality or any other provisions of this application, my breach may, in the sole discretion of Producer or NBCUniversal result in my being disqualified to participate as a participant in the Program. I further acknowledge that a breach by me of any of the confidentiality provisions of this application would cause Producer and NBCUniversal irreparable injury and damage that cannot be reasonably or adequately compensated by damages in an action at law, and, therefore, I hereby expressly agree that Producer and NBCUniversal shall be entitled to injunctive and other equitable relief to prevent or cure any breach or threatened breach of any of the confidentiality provisions of this application by me. I also recognize that proof of damages suffered by Producer and NBCUniversal in the event that I breach any of the confidentiality provisions of this application will be costly, difficult, and inconvenient.
12) As used herein, “Producer” shall include Green Bottle Pictures, Inc., its licensees, successors and assigns, and each of their respective parents, subsidiaries, and affiliates, and each of their respective officers, directors, shareholders, employees, agents, representatives, successors, licensees and assigns. I agree that Producer may license, assign, and otherwise transfer this application and all rights granted by me under this application to any person or entity.
13) CHOICE OF LAW. This application shall be interpreted under the internal,
substantive laws of the State of New York without regard to the conflicts of law provisions thereof.
14) MEDIATION & ARBITRATION. The parties agree that if any controversy or claim arising out of or relating to this application cannot be settled through direct discussions, they shall endeavor first to settle the controversy or claim by a mediation administered by JAMS under its applicable rules. IF THE DISPUTE IS NOT OTHERWISE RESOLVED THROUGH DIRECT DISCUSSIONS OR MEDIATION, THE PARTIES AGREE THAT THE CONTROVERSY OR CLAIM, INCLUDING THE SCOPE OR APPLICABILITY OF THIS AGREEMENT TO ARBITRATE, SHALL THEN BE RESOLVED BY FINAL AND BINDING CONFIDENTIAL ARBITRATION ADMINISTERED BY JAMS IN ACCORDANCE WITH ITS STREAMLINED ARBITRATION RULES AND PROCEDURES OR SUBSEQUENT VERSIONS THEREOF, INCLUDING ITS OPTIONAL APPEAL PROCEDURE (THE “JAMS RULES”, AVAILABLE AT WWW.JAMSADR.COM, INCLUDING WITHOUT LIMITATION, THE RULE PROVIDING THAT EACH PARTY SHALL PAY PRO RATA ITS SHARE OF JAMS FEES AND EXPENSES, AND THE RULES PROVIDING FOR LIMITED DISCOVERY AND OTHER EXCHANGE OF INFORMATION). THE JAMS RULES FOR SELECTION OF AN ARBITRATOR SHALL BE FOLLOWED, EXCEPT THAT THE ARBITRATOR SHALL BE AN EXPERIENCED ARBITRATOR LICENSED TO PRACTICE LAW IN NEW YORK OR A RETIRED JUDGE. ALL PROCEEDINGS BROUGHT PURSUANT TO THIS PARAGRAPH WILL BE CONDUCTED IN THE CITY OF NEW YORK. THE PARTIES AGREE THAT THE REMEDY FOR ANY CLAIM BROUGHT PURSUANT TO THIS APPLICATION SHALL BE LIMITED TO ACTUAL DAMAGES, AND IN NO EVENT SHALL ANY PARTY BE ENTITLED TO RECOVER PUNITIVE OR EXEMPLARY DAMAGES OR TO RESCIND THIS APPLICATION OR SEEK INJUNCTIVE OR ANY OTHER EQUITABLE RELIEF. NOTWITHSTANDING THE FOREGOING, I RECOGNIZE THAT GIVEN THE UNIQUE NATURE OF THE PROGRAM AND THE COMMERCIAL REALITIES OF THE ENTERTAINMENT INDUSTRY, WHICH RELY UPON CONFIDENTIALITY AND INTELLECTUAL PROPERTY RIGHTS, ANY ACTUAL OR ANTICIPATED BREACH OF MY CONFIDENTIALITY OBLIGATIONS PURSUANT TO THIS APPLICATION, OR ANY INFRINGEMENT BY ME OF PRODUCER’S OR NBCUNIVERSAL'S INTELLECTUAL PROPERTY RIGHTS, WOULD CAUSE PRODUCER AND NBCUNIVERSAL IRREPARABLE INJURY AND DAMAGE THAT CANNOT BE REASONABLY OR ADEQUATELY COMPENSATED BY MONEY AND, THEREFORE, I AGREE THAT PRODUCER AND NBCUNIVERSAL SHALL BE ENTITLED TO SEEK AND OBTAIN INJUNCTIVE AND OTHER EQUITABLE RELIEF FROM A COURT OF COMPETENT JURISDICTION FOR ANY
SUCH BREACH OR INFRINGEMENT. FURTHER AND NOTWITHSTANDING THE FOREGOING, TO THE EXTENT REQUIRED BY LAW, THE PARTIES AGREE THAT WITH RESPECT TO THE ARBITRATION OF ANY FEDERAL OR STATE CLAIM I BRING THAT ARISES FROM UNWAIVABLE PUBLIC RIGHTS, WHETHER STATUTORY OR NONSTATUTORY, THE FOLLOWING SHALL APPLY: THE ARBITRATOR MAY AWARD ANY REMEDY THAT WOULD HAVE BEEN AVAILABLE IN COURT; THE PARTIES SHALL BE PERMITTED DISCOVERY ADEQUATE TO SECURE THE NECESSARY INFORMATION TO PRESENT SUCH CLAIM OR DEFEND AGAINST SUCH CLAIM; AND PRODUCER SHALL PAY ALL TYPES OF COSTS THAT ARE UNIQUE TO ARBITRATION.
15) SEVERABILITY. THE ILLEGALITY, INVALIDITY OR UNENFORCEABILITY OF ANY PROVISION OF THIS APPLICATION SHALL IN NO WAY AFFECT THE VALIDITY OR ENFORCEABILITY OF ANY OF THE REMAINDER OF THIS APPLICATION, WHICH SHALL BE ENFORCED TO THE MAXIMUM EXTENT PERMITTED BY LAW.
I have read, understand, and agree with the foregoing. I UNDERSTAND THAT I AM GIVING UP CERTAIN LEGAL RIGHTS UNDER THIS APPLICATION, INCLUDING, WITHOUT LIMITATION, MY RIGHT TO FILE A LAWSUIT IN COURT WITH RESPECT TO ANY CLAIM ARISING IN CONNECTION WITH THIS APPLICATION.
Date of Birth*
*For verification purposes only pursuant to 18 U.S.C. §§ 2256 et seq.
CERTIFICATION OF VERACITY
1. I have voluntarily applied to participate in the television program currently entitled “THE MILLIONAIRE MATCHMAKER” (working title) (the “Program”) being produced by Green Bottle Pictures, Inc. (“Producer”) for possible exhibition by one or more cable television networks of NBCUniversal Media, LLC (“NBCUniversal”). In order to be considered as a participant in the Program, I have made and will make statements and representations to Producer and to NBCUniversal regarding myself and my background. I understand that this information is being relied upon by Producer and by NBCUniversal in considering me for selection as a participant in the Program.
2. I hereby certify, represent and warrant that all statements, disclosures and representations made by me in my application to participate in the Program, in any other document or agreement that I have signed or will sign in connection with the Program or my participation in the Program, and that I otherwise provide to Producer, to NBCUniversal, or to anyone acting on their behalf, are true, accurate and complete. Without in any way limiting the foregoing, I certify that I have not withheld or mischaracterized any information regarding myself or my background. I also agree to immediately inform the Producer and NBCUniversal if any of the information I provide becomes inaccurate or incomplete at any time prior to the exhibition of the final episode of the Program.
3. If any statement, disclosure or representation is or becomes false, misleading or incomplete, Producer and/or NBCUniversal may remove me from consideration as a participant in the Program, may remove me from the Program, and/or may withhold from me or cause me to return any items that I have received, including, without limitation, any items already delivered to me.
4. I also recognize that proof of damages suffered by Producer and NBCUniversal in the event that I breach any provision of this certification will be costly, difficult and/or inconvenient. Accordingly, I agree to pay Producer and NBCUniversal the sum of One Hundred Thousand Dollars ($100,000) per breach plus disgorgement of any money or the value of anything that I may receive in connection with my breach as liquidated damages in the event I breach any provision of this certification. Furthermore, I will indemnify and hold harmless Producer, NBCUniversal, and their respective parent, subsidiary and affiliated companies, and each of their respective officers, directors, agents, representative and employees, from and against any and all claims, actions, damages, liabilities, losses, costs and expenses (including, without limitation, attorneys’ fees) that in any way arise out of or result from my breach of any provision of this certification.
ACCEPTED AND AGREED:
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