Truck Republic

COMPETITORS

Thank you for your interest in 51 Mind's new show, Truck Republic!

Do you have a PASSION for your PICK-UP TRUCK?
Are you ready to pit your BEAST OF STEEL against THE BEST?

TEST YOUR VEHICLES' SPEED, STRENGTH AND AGILITY IN INCREASINGLY UNORTHODOX WAYS!

Truck Republic is a NEW COMPETITION SERIES where REAL AMERICANS and their PICK-UPS will go HEAD TO HEAD in a competition like no other.

EACH EPISODE, 4 AMERICANS AND THEIR TRUCKS WILL COMPETE IN A HIGH-OCTANE SHOWDOWN OF MAN AND MACHINE.

If you think your TRUCK* can be the KING OF THE HILL and compete for a potential LARGE CASH PRIZE, complete the form below.

IF YOU WOULD LIKE TO APPLY AS AN EXPERT INSTEAD, CLICK HERE.

First Name *

Last Name *

Mobile Phone *

Other Phone

Email *

Street Address

City *

State *

Zip Code

Date of Birth* *

*FOR VERIFICATION PURPOSES ONLY, PURSUANT TO 18 U.S.C. §§ 2256 ET SEQ.

If required, are you able to provide documentation that you are one of the following: U.S. Citizen, U.S. Permanent Resident (green card holder), Temporary Resident (as defined by U.S. immigration law),) Asylee or Refugee *

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Any other personal website or social media site.

What industry do you work in? *

What is your current occupation? *

Please list your 3 previous jobs. *

What type of driver are you? *

Are you currently or have you ever been sponsored? *

If you are currently or have ever been sponsored, please list with whom and when.

If you have ever competed, please list the competition(s), the city/state of the competition(s), year and what you and your truck placed. *

Do you own a pick-up truck? *

How many pick-up trucks do you own? *

What is the make, model and year of your pickup truck(s)? *

Have you made any modifications to your truck? If yes, please list. *

If you haven't made any modifications to your truck, please write "none".

Tell us more about your truck(s). Do you feel like it's just a vehicle, or does it mean more to you? How often do you work on the truck? Where do you drive it? Has it ever competed in a course? Does it have a name? *

If you are selected to compete on TRUCK REPUBLIC, you must have a crew. This does not mean a professional crew. Your crew can be made up of family and friends. Please list who you would like to be apart of your crew, their relationship to you and include what contribution he/she has made to the truck over the years, if any. *

Why do you want to compete on TRUCK REPUBLIC? *

Have you ever been convicted of any crimes, including a misdemeanor or a felony? *

If YES, please describe in detail, and include date, city, state, charge and sentence for each incident.

Have you ever had a temporary or permanent restraining order placed against you or has anyone sought a temporary or permanent restraining order against you? *

If YES, explain (include date, city, state and circumstances).

Please upload a recent photo of YOU. *

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Please upload a recent photo of your TRUCK. *

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How did you hear about the casting for Truck Republic? Please Be Specific: (i.e. castingduo.com, craigslist...etc.)? * *

PLEASE READ AND ACCEPT THE FOLLOWING *

ELIGIBILITY REQUIREMENTS AND RELEASES 1) You must be at least 18 years of age as of the date you fill out this Application and Release. 2) You must be a legal US resident. You must be legally authorized to live, work and participate in the Program in the United States. 3) You must not be a candidate for public office and must agree not to become one until after one (1) year after the initial exhibition of the episodes of the Program in which you appear, if selected as a participant. 4) 51 Minds Entertainment, LLC (“Producer”) and A&E Television Network (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. Producer and A&E Television Network may also consider whether you or any member of your immediate family or anyone living in your household 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 reality-based program currently entitled “Truck Republic” (the “Program”) or any variation thereof; (ii) A&E Television Network or any station or network owned and operated by A&E Television Network or any of its parent, subsidiary or affiliated entities (collectively, “Network”); (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.” 5) If you are selected as a potential participant you must execute waivers and release agreements required by Producer and Network or any of their licensees, successors or assigns. 6) You will need to be available to the production on dates designated by Producer (and such dates are subject to change in Producer’s sole discretion) and be willing to travel to various locations as part of production. 7) Any offer to become a participant may be conditioned upon your submission to a background check and psychological evaluation, in accordance with applicable laws. CASTING RELEASE I, ________________________________________________, desire and agree to voluntarily participate in the various activities (collectively, "Activity") related to the auditioning, casting, development and/or production of the television program tentatively entitled "Truck Republic " (the "Program") being produced by 51 Minds Entertainment, LLC (“Company”) and/or its designees (collectively, "Producer"). I understand and acknowledge that I shall not receive any monetary compensation or any other remuneration for my participation and/or appearance in connection with the Program, any Activity, the casting/audition of the Program and/or for the exercise of any other rights granted by me herein. I further acknowledge and agree that none of Producer's rights under this release are in any way contingent or dependent upon Producer including me as a participant in the Program. In consideration of Producer considering me as a potential participant in the Program and for the opportunity to possibly appear on television, and for other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, I hereby acknowledge and agree as follows: (a) Likeness and Performance: I hereby consent to Producer taping, photographing, filming and/or other recording of, use and reuse of my name, likeness, caricature, voice (including, without limitation, my speaking, singing, rapping voice) personality, image, actions, personal experiences, biographical information, biographical material, and life story (collectively "Likeness"). I further agree that Producer may tape, photograph, film and otherwise record, depict, portray and represent my Likeness, my actions, performances, exploits, events, incidents, situations and experiences contained in or associated with my participation in any Activity and/or the Program (including, without limitation, in connection with the casting and auditioning for the Program), as well as any audio-visual recordings and/or photographs of me taken during the participant selection process and any materials submitted by me (or that I may submit), including, but not limited to, photograph(s) (each a “Photograph”), drawings, plans, prototypes, documents and/or video(s) submitted by me or otherwise in connection with the Program (each, a “Video Submission”); and, collectively, with the Photographs and/or Video Submissions and/or any materials submitted by me, “Materials”) (all of the foregoing, my "Performance"), for use in and/or in connection with the Program and the Productions (as defined below). Without limiting the foregoing, any name used in connection with any portrayal of me in or in connection with the Program or any of the Productions may be fictitious or my real name. Notwithstanding anything contained in this agreement or any related documents provided to me by Producer, I understand and agree that Producer has no obligation to include me in any Activity or the Program, to choose me to participate in the Program, to include the Activity or me in the Program, or to produce or exploit the Program. (b) In connection with my participation and/or potential appearance with the Program, any Activity, and/or the casting/audition of the Program, I may elect to participate in certain activities involving riding on and/or operating a pick-up truck, off-road vehicle and/or similar conveyance (“Vehicle”) on such surfaces as pavement, grass, gravel, sand, and/or other material, and/or on terrain which may be hard, soft, inclining, declining, rocky or uneven in nature and/or other activities, which may be hazardous, strenuous and/or risky (the “Hazardous Activities”). I acknowledge and agree that the Hazardous Activities may be hazardous, strenuous and/or may cause serious injury, emotional and/or physical distress and stress, and/or death. I acknowledge and agree that it is my responsibility to take appropriate health and safety precautions, including, without limitation, with respect to the use of protective body and/or head gear and other safety equipment and/or to operate such Vehicle in a manner in accordance with all applicable laws in connection with the Hazardous Activities, including, but not limited to, operation of the Vehicle in accordance with all speed limits, safe and lawful driving techniques and helmet laws (as applicable). I agree to follow all of Producer’s directions and instructions in all matters. Any actual or alleged consequences of my following such directions and instructions shall be included within the matters released and indemnified hereunder. Although Producer shall be taking precautions to protect my safety, I understand and acknowledge that no such precautions can completely eliminate the risks associated with my participation in the Hazardous Activities. I represent and warrant that I am physically fit and able to participate in, and mentally capable of participating in the Hazardous Activities. I understand the risks of participating in such Hazardous Activities, and I acknowledge that while conduct that gives rise to such situations might otherwise constitute an actionable tort or give rise to other claims or causes of action, I have freely consented to such conduct and have assumed the risks thereof. I also understand that Producer has made no representations or warranties of any kind regarding my qualifications, ability or fitness to participate in the Hazardous Activities, and that the waivers, releases and indemnities contained in this agreement and any other agreement that I have executed or may execute in the future related to the Program expressly apply to my participation in or presence around any such Hazardous Activities and in the locations for the Program. I further agree that such Hazardous Activities may be filmed, taped, photographed and recorded by Producer for possible inclusion in the Program. I hereby acknowledge and agree that my participation in the Hazardous Activities is voluntary, has not been influenced by Producer or any Program personnel, and is not required as a condition of my potential participation in the Program or otherwise. Producer’s involvement with the Hazardous Activities is limited to photographing, filming, recording and portraying such Hazardous Activities to the extent desired by Producer for inclusion in the Program and otherwise. I assume any and all risks associated with my potential engagement by Producer and/or my potential appearance and potential participation in the Program, including, without limitation, in connection with the Hazardous Activities, and I freely and knowingly accept and assume any and all risks of the foregoing Hazardous Activities as well as any risks not mentioned herein that are associated with my participation in the Program. (c) Producer's Instructions/Further Documents: I will accept as final any and all decisions made by Producer on any and all matters (including, without limitation, the audition/casting process and participant selection). I understand that my failure to comply with any such rules and/or instructions as provided to me by Producer may result in my immediate disqualification from further consideration to become a participant in the Program, in Producer’s sole discretion. I acknowledge and agree that Producer is in no way obligated to grant me an audition, regardless of either my place in the audition line or any prior statements or assurances made to me by Producer or its employees, agents or vendors. I further acknowledge and agree that Producer, may, at any time and in its sole discretion, alter the audition and participant selection process in any manner. I agree to execute such other documentation, releases and agreements as Producer shall request from me from time to time, at its sole discretion, including, without limitation, a long-form participant agreement in the event Producer selects me as a participant in the Program. (d) Ownership of Performance/Program: I agree that Producer shall be the exclusive owner of all copyright and other rights in and to the Program and my Performance and will be able to use them forever and throughout the universe, and to license others to use them, in any manner Producer wishes and in any and all media, manners and/or platforms now known or hereafter discovered or developed, in or in connection with the Program and/or in theatrical motion pictures, television programs, theatrical stage presentations, radio, wireless content, internet programming, and any and all other audio, visual, audio-visual and/or print works and productions of any kind or description, now known or hereafter devised (collectively "Productions"), whether related to or in connection with the Program or not. I further agree that Producer may use and license others to use the Performance and/or excerpts or reproductions therefrom, and my Likeness in the Program, in any related or unrelated derivative versions and/or uses of the Program (including, without limitation, any serialization(s), translation(s) and/or adaptation(s) thereof), in Productions and in and in connection with the advertising, marketing and promotion of the Program, Productions (including over the Internet), Producer and/or Network (and any of its affiliated networks) in any and all media, manners and platforms, including, without limitation, in and in connection with merchandising and commercial tie-ins. I acknowledge that Producer may record my Likeness and Performance by way of open or hidden microphones and/or cameras at any and in the vicinity of all locations in which any Activity takes place (including, without limitation, the auditions or tryouts for the Program). I acknowledge and agree that the Program or any part thereof (including without limitation my Likeness and/or Performance) can be edited, cut, added to, adapted, dubbed, modified and/or rearranged at Producer’s sole and absolute discretion, and may be used as part of or separate from the Program. Without limiting the foregoing, I acknowledge that Producer may juxtapose any recordings of my Performance with any other part of the recording of my Performance in the Program or otherwise, and alter the sequence of events or of any questions posed and/or answers given in connection with my Performance and the Program. I acknowledge that the use of my Likeness, and/or Performance in the Program could be embarrassing, disparaging, surprising, of an unfavorable nature, factual or fictional, or portray me in a false light. I hereby consent to any such use and acknowledge and agree that the Released Claims (as defined below) include any and all claims which I may be otherwise entitled to as a result of such use of my Likeness and/or Performance. I understand and acknowledge that my appearance and participation with the Program and/or Productions does not fall under the jurisdiction of any collective bargaining agreements, and that I shall not be entitled to any residuals or any other types of payments in connection with the Program, Productions or Producer’s use of my Likeness and/or Performance as provided herein. (e) Musical Compositions: In the event I perform any musical composition (lyrics, rap, music/melodies and/or both) written or controlled by me (an "Original Composition") in connection with my participation in an Activity and/or the Program (including, without limitation, during the auditions, tryouts for the Program and/or the Program), I hereby grant to Producer, without charge or the need for any additional documentation, the non-exclusive, unlimited, royalty-free, worldwide, perpetual right and license to use, synchronize, reproduce and perform such Original Composition in and in connection with the Program, and advertising, publicity and promotion for the Program and related and ancillary uses, in all media and by any and all manner or means now known or hereafter devised (including without limitation exploitation of the Program via the Internet) (collectively, the "Composition Rights"). To the extent I desire to perform any musical composition (lyrics, music/melodies and/or both) partially written or partially controlled by me (a "Joint Composition") in connection with my participation in an Activity and/or the Program (including, without limitation, during the auditions, tryouts for the Program and/or the Program), I hereby (i) grant to Producer, to the full extent of my ownership and control of such Joint Composition, the Composition Rights in connection with such Joint Composition, and (ii) agree to provide to Producer such consents, licenses or other documentation as required by Producer in form and substance acceptable to Producer, granting Producer the Composition Rights for the Joint Composition (the "Joint Composition Licenses") from any and all persons and/or entities who either own or control any portion of the Joint Composition. I acknowledge and agree that I shall not sing, mimic, copy or otherwise perform any other musical composition other than Original Compositions and/or Joint Compositions for which I shall obtain a Joint Composition License. (f) Representations and Warranties: I confirm that, to the best of my knowledge any statements made by me to Producer at any time in connection with the Program (including, without limitation, during any auditions and/or casting sessions) shall be true and that neither my statements nor any of my actions will violate or infringe upon any third party's rights. In addition to any other representations and warranties contained herein, I further represent and warrant that (i) I am in good health; (ii) I am not under the influence of any medication, drugs, or other substance that might impair my physical or mental ability to engage in the Activity and/or the Program or that might impair my judgment while engaging in the Activity and/or the Program; (iii) I will follow all rules made and directions given by Producer in connection with the Activity and/or the Program; (iv) my Performance, if any, (including, without limitation, any performance of an Original Composition) and any statements made by me and any information, music, lyrics, composition or materials provided by me to Producer in connection with the Activity and the Program shall be wholly original with me and shall not slander, libel, or violate any rights of any third parties; and (v) I am at least 18 years old upon execution of this agreement. Further, by signing below and submitting the application, I warrant and represent that everyone appearing in any Photograph(s) and/or Video Submission(s) and anyone who may have taken such Photograph(s) and/or shot such Video Submission(s) agrees that such Photograph(s) and/or Video Submission(s) may be used, as edited, altered, or modified by the Releasees, in any and all media, whether now known or hereafter devised, throughout the universe, in perpetuity, including, without limitation, in and in connection with the development, production, distribution, exhibition and/or exploitation of the Program, and the advertising, promotion, publicity, marketing, and merchandising thereof, without any compensation whatsoever. I further warrant and represent that I have all rights, licenses, permissions and consents necessary to submit the Materials and to grant all of the rights that I have granted to Producer herein, and that Ihave obtained written permission when taking any Photograph(s) and/or recording each and every part of the Video Submission(s) on private property not owned or controlled by me, where such permission is required. (g) RELEASE: I, ON BEHALF OF MYSELF, MY HEIRS, NEXT OF KIN, SPOUSE OR PARTNER, GUARDIANS, LEGAL REPRESENTATIVES, EXECUTORS, ADMINISTRATORS, SUCCESSORS AND ASSIGNS (COLLECTIVELY, THE "RELEASING PARTIES") HEREBY AGREE NOT TO SUE AND IRREVOCABLY AND UNCONDITIONALLY RELEASE, WAIVE AND FOREVER DISCHARGE PRODUCER, EACH OF THEIR RESPECTIVE PARENT AND RELATED COMPANIES, SUBSIDIARIES (WHETHER OR NOT WHOLLY-OWNED), AFFILIATES, DIVISIONS, AND EACH OF THEIR RESPECTIVE PAST, PRESENT AND FUTURE OFFICERS, AGENTS, REPRESENTATIVES, EMPLOYEES, SUCCESSORS AND ASSIGNS, JOINTLY AND INDIVIDUALLY (COLLECTIVELY, "RELEASEES"), FROM ANY AND ALL MANNER OF LIABILITIES, CLAIMS AND DEMANDS OF ANY KIND OR NATURE, WHATSOEVER, IN LAW OR EQUITY, WHETHER KNOWN OR UNKNOWN, SUSPECTED OR UNSUSPECTED, AND WHETHER OR NOT CONCEALED OR HIDDEN, THAT I MAY NOW HAVE OR MAY HEREAFTER HAVE(COLLECTIVELY, THE "RELEASED CLAIMS") WHICH ARISE OUT OF OR RELATE TO OR IN CONNECTION WITH THE CASTING, AUDITION, ANY ACTIVITIES, ANY HAZARDOUS ACTIVITIES, PRODUCTION, REPRODUCTION, EXHIBITION, BROADCAST, DISTRIBUTION, ADVERTISING, PROMOTION OR OTHER EXPLOITATION OF THE PROGRAM, ANY OF THE PRODUCTIONS, THE EXERCISE OF ANY RIGHTS IN THE PROGRAM OR ANY OF THE PRODUCTIONS OR OF ANY RIGHTS GRANTED HEREUNDER WHICH I OR ANY OF THE RELEASING PARTIES EVER HAD, NOW HAS, OR IN THE FUTURE MAY HAVE AGAINST THE RELEASEES. THE RELEASED CLAIMS SHALL INCLUDE, WITHOUT LIMITATION, CLAIMS BASED ON NEGLIGENCE, GROSS NEGLIGENCE, PERSONAL INJURY, DISABILITY, DEATH, PROPERTY DAMAGE, LIBEL, SLANDER, DEFAMATION, INVASION OF ANY RIGHTS OF PRIVACY, RIGHT OF PUBLICITY OR PERSONALITY, INTENTIONAL INFLICTION OF EMOTIONAL DISTRESS, NEGLIGENT INFLICTION OF EMOTIONAL DISTRESS, INFRINGEMENT OF COPYRIGHT OR VIOLATION OF ANY OTHER RIGHT. (h) Indemnification: I and the other Releasing Parties unconditionally and irrevocably agree to defend, indemnify and hold harmless each of the Releasees from and against any and all claims, demands, liens, agreements, contracts, actions, suits, costs, attorneys' fees, damages, judgments, orders and liabilities of any kind or nature in law, equity or otherwise, by whomever asserted, arising out of or in connection with (i) my breach or alleged breach of any agreement, covenant, representation, warranty in this Agreement (ii) arising out of or in connection with my participation and appearance in or elimination from the Program or activities associated with the Program, including without limitation the Released Claims or (iii) the malfeasance and/or negligence and/or other tortious acts or omissions committed by me and/or any agent, employees guest or invitee of mine. In the event of any claim or service of process upon any of the Releasees involving the indemnification set forth above, Producer or such other of the Releasees shall notify me of the claim. The Releasees may elect to take such action on behalf of itself and/or as attorney-in-fact for me to adjust, settle, defend or otherwise dispose of such claim, in which case I shall, upon being billed therefore, reimburse each of the applicable Releasees in the amount thereof. (i) 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, the business of Producer or Network, any program produced by Producer and/or exhibited by Network, 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 “Confidential Information”). I acknowledge and agree that the Confidential Information is confidential and the exclusive property of Producer and/or Network. At no time will I ever, directly or indirectly, divulge in any manner or use or permit others to use any of the Confidential Information. I acknowledge and agree that my obligations with respect to confidentiality set forth in this application shall continue in perpetuity or until terminated by Network 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 and/or Network 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 Network 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 Network shall be entitled to injunctive and other equitable relief to prevent and/or cure any breach or threatened breach of any of the confidentiality provisions of this application by me. (j) Choice of Law: This application shall be interpreted under the internal, substantive laws of the State of California, without regard to the conflicts of law provisions thereof. (k) Miscellaneous: I acknowledge and agree that the rights granted hereunder and my participation related thereto are unique, unusual, special and extraordinary, the loss of which would not be adequately compensable in damages in an action at law, and that, in addition to any rights or remedies which Producer may have under this Release or otherwise, Producer therefore would be entitled to all available equitable remedies in case of breach or threatened breach of this Release by me. I further agree that in the event I breach this agreement and/or bring a claim or lawsuit in violation of this agreement, I shall be liable for any outside attorneys' fees and costs incurred by Producer and/or Network in connection with such breach, claim or lawsuit. I expressly acknowledge and agree that no breach of this Release or violation of any my rights shall entitle me to terminate or rescind the rights granted to Producer herein and in the event of any question of Producer’s performance of its obligation hereunder, I hereby waive the right, in the event of any such breach, to equitable relief or to enjoin, restrain or interfere with the exercise or any of the rights granted herein, it being my understanding that my sole remedy shall be the right to recover monetary damages with respect to any such breach, but in any event, no consequential, punitive or special damages. I represent and warrant that I had the opportunity to review this release before signing and that I have the right to enter into agreements under my own name. The invalidity or unenforceability of any part of this release shall in no way affect the validity or enforceability of the remainder of this release. This release and the rights hereunder may be freely assigned by Producer.

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