WHO WANTS TO BE A MILLIONAIRE APPLICATION

_________________________ Last Name _________________________ First Name _________________________ Date of Birth _________________________ Last 4 digits of SSN

_____________________________________________________ Street Address _____________________________________________________ City State Zip _____________________________________________________ E-Mail Address If you are selected from the Contestant Pool as a potential contestant, you must be available for a qualifying phone call. Please list the phone number (no pager numbers) where you can be reached Monday through Friday between 9am and 5pm Eastern Time. ___________________________________________________________________________ Phone Numbers (inc. area code). Please Indicate Home, Work, or Cell

____________________________________________________________________________ Secondary Contact Person: (provide name, cell phone number & relationship to you)

If contacted by Who Wants to Be a Millionaire staff, all applicants must return phone calls Monday through Friday between 9am and 5pm EST

ELIGIBILITY Are you or any member of your immediate family (spouse, mother, father, daughter, son, sister, brother and their spouses) or anyone living in your household currently employed by: A) The Walt Disney Company, its parent companies, subsidiaries, affiliates, agents or representatives? Y _____ N _____ B) Any television station that broadcasts Who wants to be a Millionaire? Y ____ N ____ C) Embassy Row, its parent companies, subsidiaries, affiliates, agents or representatives? Y ____ N____ D) Any person or entity connected with the production, administration or judging of Who wants to be a Millionaire? Y ____ N____ Have you ever appeared on Who Wants to be a Millionaire? Hot Seat? Y ____ N ____ Fastest Finger? Y ____ N ____ Have you ever appeared on a TV game show? Y_____ N_____ If yes, which show(s)________________________________ _________________________________________________ When? ______________________________ Are you scheduled to appear on a TV game show? Y_____ N_____ If yes, when? _______________________________ Do you or any member of your immediate family or anyone living in your household know any persons who are or have ever been connected with the production, administration or judging of Who Wants to be a Millionaire? Y ____ N____ Contestants are solely responsible for all expenses incurred in connection with their appearance on the Syndicated Program with Meredith Vieira including, but not limited to, travel to New York City, hotel, meals and all other expenses. The Program Sponsor will not reimburse any Contestant for such expenses. Do you agree to be responsible for all costs incurred by you in connection with your appearance on the Syndicated Program? Y ____ N ___

WHO WANTS TO BE A MILLIONAIRE AUDITION APPLICATION

Married __________ Single __________ Attached _________ Kids? _________

____________________________________________________________________________ Education (Name(s) of Colleges and Degrees) ____________________________________________________________________________ Occupation

Please answer the following questions: 1. Quirks, rituals, superstitionsWhat makes you unique?

2. How would winning $1 million change your life?

3. What is one thing you do that makes people laugh?

4. If you could nominate yourself as best-_____ or most likely to_____, what would be your vote?

5. What do you do for fun?

6. Youd never believe it but I once

7. Why do you want to be on Millionaire?

8. How did you hear about the audition?

9. Have you previously auditioned to be a contestant on Millionaire? If so, when was the date of your last audition? And how many times have you auditioned to be a contestant in the past?