2023 PODIUM PROMOTIONS MEDIA CREDENTIAL APPLICATION

MEDIA CREDENTIALS APPLICATION

– NO MEDIA CREDENTIAL REQUEST WILL BE ACCEPTED ONSITE –
- REQUEST FORMS MUST BE SUBMITTED 1 WEEK PRIOR TO RACE DATE
- ALL MEDIA are required to complete this form in its entirety.
- All credential applications will be reviewed for approval, and applicants will be notified.
- The submission of this form does NOT guarantee receipt of credentials.
- Media credentials are non-transferable.
- All credentialed media members must be at least 18 years of age.
- Credentials will be issued at Media Registration. Time and location will be announced prior to the race. Proper identification will be required. Additional information available at WORCSRacing.com
- Gate and camping fees are your responsibility.
Podium Promotions reserves the right to terminate media credentials for any reason and impose future bans to events and or ask you to leave the track at any time.
YOUR MEDIA CATEGORY*
FULL NAME ON MEDIA CREDENTIALS:*

First NameLast Name
I CERTIFY THAT I AM OVER THE AGE OF 18 - (YOUR DRIVER'S LICENSE WILL BE USED TO VERIFY WHEN PICKING UP CREDENTIALS

YesNo
MEDIA OUTLET:*
EMAIL:*

Confirmation Email
PHONE NUMBER:

Area CodePhone Number
WEBSITE ADDRESS:*
CHECK CATEGORY THAT WILL APPLY TO YOUR CREDENTIALS:*
ALL SOCIAL MEDIA ACCOUNTS WHERE POTENTIAL MEDIA WILL BE POSTED. PRESS THE + TO ADD FIELDS AS NEEDED*
WILL YOU BE OPERATING A DRONE? IF YES, PLEASE ATTACH DRONE INFORMATION IN NEXT SECTION. PLEASE BE AWARE THAT NOT ALL EVENT SITES ALLOW DRONES TO BE FLOWN.S, PLEASE ATTACH DRONE LICENSE AND INSURANCE INFORMATION DOWN BELOW*

YESNO
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MEDIA CONTRACT AND WAIVER REQUIRED
1) I hereby acknowledge that any photos, pictures, video or other media forms taken at any of the 2022 WORCS events will be used for media purposes only (i.e. magazines, newspaper, social media, blogs, vlogs, etc.). I also agree to give all rights of the photographs, video or other media taken at any Podium Promotions LLC, (PP) event, the controlling body of WORCS Racing, to be used at PP’ discretion and media must be sent ot PP upon request. *
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2) I also hereby acknowledge that I must wear a media vest AT ALL TIMES I am working the event. If media personal does not have media vest, PP will provide one for the event weekend. The vest MUST be returned at the end of the weekend to PP official or you will be charged a non-return fee of $20 dollars.*
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3) I hereby acknowledge that I am entering a live course at my own risk and I will not place myself in harm’s way or that of a racer, spectator, or PP official to obtain a photograph or video. *
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4) I herby acknowledge that I must give the right of way to WORCS’ contracted videographer, photographer and WORCS staff at all times and interference, disruption, unprofessional behavior will result in an immediate dismissal from said event. *
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5) DRONE OPERATION: I certify that I have a license to operate a drone and that I have drone operator’s insurance. Use NA if not applicable. (Attach drone documents below) PLEASE BE AWARE THAT NOT ALL EVENT SITES ALLOW DRONES TO BE FLOWN.*
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6) DRONE DOCUMENTS IF APPLICABLE. BOTH INSURANCE AND LICENSE MUST BE ATTACHED.

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7) I agree to the above statements and hereby acknowledge that PP events are inherently dangerous, and I have had sufficient experience to understand all the risks involved with PP Events. I understand that there are risks (including serious bodily harm or death) in photographing these live PP events and express to voluntarily assume all risk of personal injury or death sustained while photography PP events, whether or not caused by the negligence or other fault of PP. *
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8) I, the undersigned, do herby for myself, my heirs, executors, and assigns, release, remise and forever discharge and agree to indemnify and hold harmless individuals, officers, agents, sponsors, co-sponsors, sanctioning bodies, servants, land owners, vehicle owners, lessees of premises used to conduct the event, employees, from every claim, demand, action of whatsoever kind or nature and any cost, lost or expense in connection therewith arising from or any reason of or on the occasion of any use by, of the Podium Promotions LLC course or related facilities including any claims or demands for injury to, or death of any person or damage to, or destruction of, any property resulting from or claim to result from or arise out of accident or occurrence during or in connection with said use including specifically such as may arise out of or be claimed to arise out of negligence on the part of said Podium Promotions LLC.*
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9) I understand that Podium Promotions reserves the right to terminate media credentials for any reason and impose future bans to events and or ask you to leave the track at any time.*
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10) I understand that gate and camping fees are the media member's responsibility.*
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11) I understand that my email will be added to the WORCS Media email list. You may opt out at anytime in the future. *
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BY TYPING YOUR NAME BELOW, YOU ARE DIGITALLY SIGNING THE YOU HAVE COMPLETELY AND ACCURATELY COMPLETED THE INFORMATION AND THAT ANY MISREPRESENTATION ON YOUR PART WILL RESULT IN BAN FROM FUTURE EVENTS.*
DIGITAL SIGNATURE
TODAY'S DATE:*

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