Sasuke Malaysia Application Form

Personal Information

Name *
Prefix
First *
Last *
Suffix
Gender *
 Female  
 Male 
Age *
Date of Birth *

MM		/
DD		/
YYYY
I/C Number *
Address *
Street Address *
Address Line 2
City *
State / Province / Region *
Postal / Zip Code *
Country *
Phone Number(House) *
Email
Phone Number(HP) *
Nationality *
Race *
Religion *
Marital Status *
 Single 
 Married 
Health Problem *
 Yes 
 No 
If yes, please explain:
Weight(kg) *
Height(cm) *
Occupation *

Tell Us Something Interesting about yourself:-

Interest *
Upload a PHOTO of you *

Terms & Conditions

1- You must be at least 16 years of aged
2- You must be a lawful Malaysian resident
3- Must have a valid Passport
4- If selected as a participant you must execute waivers and release agreements required by Sasuke Malaysia Sdn Bhd.
5- You will need to be available for the production dates May 27-29 2011 and be willing to travel to various locations as part of the production.
6- Sasuke Malaysia Sdn. Bhd will not be responsible for any injuries caused during production.
7- 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; (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 Program, contestant selection process, and/or from the Program contest, if selected; (iv) all decisions by Producer concerning selection of the contestants is final and not subject to challenge or appeal; and (v) Producer has no obligation to return and materials submitted by me as part of the application whether or not I am selected as a contestant.
b. By submitting this application, I hereby consent to the recording, use and reuse by Sasuke Malaysia Sdn. Bhd, 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 obtains in connection with my application to be a contestant in the Program or in any materials submitted by any of the other Releasees, in any and all media know or hereafter devised, in or in connection with the Program. 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 Releasees may use my Likeness in any and all media known or hereafter devised worldwide, in perpetuity. I further agree that Releasees may use my Likeness and the Materials in connection with any promotion, publicity, marketing or advertisement for the Program. I grant the rights hereunder whether or not I am selected to participate in the Program in any manner whatsoever.I agree to not make claim against Releasees as a result of the recording or use of my Likeness and/or the Materials (including, without limitation, any claim that such use defames me or invades any right of privacy and /or publicity). I agree that I shall have no right to seek or obtain injunctive or equitable relief hereunder. I understand that I will not be pain any money for giving Releasees these rights or for signing this agreement.
Do you agree with the terms and conditions? *
 Yes, I agree. 
Initial *
Date *

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YYYY
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