Media Request Formadmin2019-07-10T17:50:13+00:00 Name of Media Represented Media Assignment WriterPhotographerVideographerOther Is a Press Box Seat Needed? NoYes Type of Media (Print, Radio, Television, Web) -- include Station, Town, and website link Event Requested Your Name Your Email Address City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code Phone Emergency Contact Name & Phone Number Editor Name and Number TERMS & CONDITIONS AGREEMENT / RELEASE (Please read carefully) I hereby certify that I am an independent contractor, assuming all responsibility for myself as a result of my participation in theThunder on the Hill Racing Series events. I am not an employee, servant, or agent of the event. I hereby agree to abide by all rules and regulations. Print / Photos - Media accreditation terms and conditions include (but are not limited to) the provision that any stories produced and/or still photographs taken at each event will be used for media coverage only and not for personal gain. Media credentials are not intended for those who sell photos or images for purposes other than editorial coverage. Credentials WILL NOT be issued to those involved in commercial ventures unless written consent is obtained in advance. Photographers must attend a pre-event meeting to learn event rules and restricted areas. Photo vests must be worn at all times. Television/Video/Broadcast- The Thunder on the Hill Racing Series maintains the exclusive right to film/broadcast of its events, and reserves the right to restrict access to any video or audio recording devices at any time without notice. In all cases, prior approval and notification of presence is required before videotaping or audio recording. No live streaming of audio or video is permitted without prior written consent. News highlight video clips are permitted after events of that day are completed. The undersigned understands and agrees that he/she and beneficiaries, executors and assigns will be entitled to the benefits of insurance coverage provided the Thunder on the Hill Racing Series for accidental injuries or death which occur as the result of external, violent and visible means sustained during the event. The coverage of said policy shall constitute the limit of liability for such injuries occurring to the undersigned, in any event, provided proper notification of such occurrence is filed with theThunder on the Hill Racing Series management prior to that person leaving the speedway property. The undersigned fully understands that a race car exposes him/her to risks which can lead to serious bodily injury or death. The undersigned voluntarily assumes these risks. WITH MY SIGNATURE BELOW, I CERTIFY THAT I HAVE READ AND FULLY UNDERSTAND THIS AGREEMENT. I AGREE TO ABIDE BY ALL TERMS OF THIS AGREEMENT AND THE RULES OF the Thunder on the Hill Racing Series I agree to the terms listed above Please Note: Credentials will not be accepted two weeks before each event. No exceptions! Press Box seating, if available at the arena, is limited. If required, a grandstand seat can be assigned. These passes do not guarantee access to the infield or floor area around the speedway. All Photographers/Videographers will be required to wear a vest that is visible at all times. It would also be appreciated if you e-mail us five to six “special” photos from your visit to our event; preferably “crowd”, “candid” or “unique action” shots that can be used in our future promotional material. Please send those photos to firstname.lastname@example.org No tables or ladders are allowed in the infield or concourse at any time. Confrontations between Photographers/Videographers and the Thunder on the Hill Racing Series staff will not be tolerated at any time and can result in revocation of the Pass.