MEDIA APPLICATION

APPLY FOR CREDENTIALS

Media is welcomed and appreciated at our racetrack. The media application is not for the general public, but accredited media professionals and team photographers who intend to publish written or digital medium who need trackside access. Media is required to wear a track issued safety vest which is issued after attending a safety briefing. Submission of this form does not guarantee the issuance of a media credential. Once submitted, all applications will be reviewed and notified in email within 10 DAYS PRIOR TO THE EVENT. Bark River International Raceway/the Director of Development/Champ Off-Road reserves the right to deny or revoke credentials at any time, for any reason.

FIRST NAME *

LAST NAME *

EMAIL *

PHONE NUMBER

COMPANY *

WEBSITE

ADDRESS

CITY

STATE

ZIP CODE

CONTACT DETAILS
Primary Job Function:

TV/Broadcast JournalistRadio Broadcast JournalistPublication PhotographerIndependent Photographer for race team or OEMOther

To be granted media access, proof of insurance is required and ISOC is required to be listed as an additional insured. The medical information below is required and please submit via fax or e-mail copies of the insurance information.

Medical Insurance Carrier

Medical Insurance Number

Known reactions or allergies to medications

Emergency Contact

Please Provide the Name and Address of the media company(s) you are representingEmergency Phone Number

Media Company Name

Media Company ADDRESS

Media Company CITY

Media Company STATE

Media Company ZIP CODE

Media Company WEBSITE

Name of Editor / Director

Please Note: Credentials will not be issued without the formal approval of your Editor/Director. Issuance of this credential is at the sole discretion of ISOC.
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I AGREE to the following terms:

Any photos taken by me at this event will be used in the performance of my duties/responsibilities with the company listed above and will not be resold.
I agree to wear an ISOC media band at all times while in the track area.
I agree to comply with any/all instructions given to me by ISOC officials.
I agree to sign the Release and Waiver of Liability, Assumption of Risk and Indemnity Agreement.
I agree to reference ISOC in all printed and aired work as a result of my assignment.
I agree to provide ISOC with two (2) copies of the work published, aired or printed as a result of my assignment via hard copy or email.

Any violation of these terms will result in immediate revocation of your credential. ISOC reserves the right to determine, at its sole discretion, what determines violation of these terms.

Thank you! Your submission has been received!

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