SURVIVOR: BUSH APPLICATION
First Name
Middle Name
Last Name
City
State
Zip Code
Cell Phone
Home Phone
Other Phone
Home Street Address
E-mail Address
Gender (circle)
Male
Other Contact
Date of Birth
Age
Height
Weight
Female
Ethnicity
Current Occupation
Marital Status
Single _____
Girlfriend _____ Name _____________________ Length of time dating ____________
How much Survivor have you seen?
None ________
A few episodes _________
A full season _________
Every episode _________
Why are you the ultimate Survivor?
On the approximate dates of May 28th to the 31st, 16 diverse and interesting castaways will be stranded in the dense
forests of Bush, Louisiana where they will find themselves living through the elements with only a limited amount of
food, water and all other comforts. Every moment of this adventure will be captured on film and later edited into a
weekly program broadcast over the internet. While competing in challenges over the course of the weekend, one by one
the castaways will vote out their tribe mates until only two remain. Then seven castaways that had been previously
eliminated will return to act as a “jury” to elect who of the final two contestants is most deserving of winning the game
and the prize. In the end, only one castaway will be able to outwit, outplay, and outlast all the rest and claim the
coveted title of Sole Survivor.
Those participating in the show are expected to be:
1.
2.
3.
4.
5.
Strong-willed
Outgoing
Adventurous
Physically and mentally adept
Adaptable to environments
The game will begin at approximately 10:00 AM on Friday, May 28th. The game will end roughly around 8:00 PM on
Monday, May 31st. Survivors must be willing to compete in difficult physical and mental challenges over the course of
the game and must also agree to stay the entire length of the weekend. Even after a survivor is voted out of the game,
they will be required to live in a sequestered area on the Survivor: Bush property separate from the game. The
eliminated contestants will attend all Tribal Council meetings that follow being voted off and will ultimately return to
vote for the Sole Survivor. PLEASE NOTE THAT DATES FOR GAME ARE SUBJECT TO CHANGE.*
If you are interested in applying for this once in a lifetime experience, contact Josh Pereira at the following:
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Home Phone: (985)-886-1482
Cell Phone: (985)-774-7375
E-mail: maijo33@gmail.com
Those participating in the show will be eating little food and will have a limited supply of water. Shelter will be provided, but space will be tight.
Challenges will be mentally and physically draining. Contestants are also expected to do regular interviews during their stay on the show and
several more after they are voted off. To be a participant on the show you must be talkative during the interviews and supply any information that
is asked. Note that certain events in the game may be re-filmed or re-enacted for the sake of the show. Survivors must stay on the Survivor: Bush
property even after being eliminated. They will be asked to attend every tribal council that occurs thereafter. The following page contains
information that must be filled out and given to Josh Pereira if you wish to be a contestant. Only those who submit complete applications will be
considered for participation.