The Hundred - Registration Form

REGISTRATION FORM

Complete this form to be a part of The Hundred with Andy Lee, zooming in from all around Australia! Help Andy tackle the big and small questions as we discover what Australia is really thinking.
Submission via OLD Google Form
Email*
example@example.com
Full Name*

First NameLast Name
ALT Name / Email
Mobile Number*
Suburb / Town*
State / Territory*

Australian Capital TerritoryNew South WalesNorthern TerritoryQueenslandSouth AustraliaTasmaniaVictoriaWestern Australia
Date of Birth*

DayMonthYear
Day-Month-Year (you must be 18 or over)
Gender*

FemaleMaleNon-BinaryOther
Occupation*
Cultural Background*

AustralianIndigenous Australian or Torres Strait IslanderAsianMiddle EasternSouth AsianEuropeanNorth AmericanAfricanSouth AmericanOther
Sexuality

HeterosexualHomosexualBisexualPrefer not to sayOther
Employment Type

Full TimePart TimeCasualContractorUnemployedStudentOther
Relationship status

SingleDe FactoMarrriedDivorcedNever marriedWidowedOther
Religion

ChristianityHinduismBuddhismIslamJudaismNo religionOther
Describe your household

Couple with childrenCouple without childrenOne-parent familyGroup householdLive with parentsLive aloneOther
How many children do you have?

012345 or more
Highest level of education

High SchoolTAFE / OtherUniversityPost-graduate studiesOther
Have you participated in The Hundred before?*

NoYes, I zoomed into a recording of the show but did not speak to AndyYes, I zoomed into a recording and spoke to Andy
If you answered YES above, please provide details
What season and/or episode did you appear on the Hundred? What did you and Andy discuss? Did you see yourself on TV?
Take a photo of yourself here...
OR, please attach a recent photo of yourself

Browse Files
Please upload a recent photo of yourself as a .jpg file Cancelof
Have you ever had any criminal convictions? Or do you have any pending convictions? *
No / Yes (please provide details)
Personal Information:

I understand that Endemol Shine Australia collects my personal information for the primary purpose of selecting participants for the production of “The Hundred” and may share my personal information with its related bodies corporate and broadcast partners for this purpose. I have read and consent to the collection, use and handling of my personal information in accordance with Endemol Shine Australia’s Privacy Collection Statement and Privacy Policy.
I agree
S3 PRODUCER NOTES
Completed S3 RX 1&2 Survey #1
Attended S3 RX 1&2
Completed S3 RX 3&4 Survey #1
Attended S3 RX 3&4
Completed S3 RX 5&6 Survey #1
Attended S3 RX 5&6
Completed S3 RX 7&8 Survey #1
Attended S3 RX 7&8
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REGISTRATION FORM