Be on Escape to the Country We're looking for contributors. So if you're fed up with living in a busy city or town and seriously thinking of moving, the BBC's Escape to the Country could help you find the perfect country home.

Fill in the online application form below or print it out and send it to: Escape to the Country, Talkback UK, 77 Woodside Road, Amersham, Buckinghamshire HP6 6AA.

Tel: 01494 733 583

Email: escape@talkbackthames.tv

If possible, please enclose a photograph with your application.

First name: Surname: Other members of the family involved in the move and ages: Current address: What new activities would you like to take up after you move? Home Tel. number: Mobile Tel. number: Work Tel. number: Email address: Occupation: Details of current property i.e. 3 bedrooms, modern house on a busy main road: What type of house are you looking for? i.e. detached, semi, terrace, flat: Number of bedrooms: House style i.e. modern, cottage, traditional: Would you like somewhere in need of renovation? YesNo What is your maximum budget? Which location do you want to move to? When are you hoping to move? Please give 3 reasons why you want to move What concerns do you have about the move? How will this effect your present employment? Which 3 amenities are essential for the location? (e.g. schools, rural, motorway access) Which 3 criteria are essential for the house? (e.g. land, study, beams) Please state whether you would be happy for your details to be passed on to other Talkback Productions YesNo Date: Signature DON'T FORGET THE PHOTOS! Disclaimer The details you supply will be treated in strictest confidence and only used by BBC staff and the service providers for the purposes of the Escape to the Country programme.