Media Credentials

2010 East Bay Raceway Park Media Credential Request Form
I am requesting the following media credentials (please check all that apply):
Reporter: ______ Photographer: ______ Other: ______
Newspaper: ______ Magazine: ______ Television: ______ Radio: ______ Online: ______

Name: _______________________________________________________________
Name of Organization/Affiliate: __________________________________________
Title: _______________________________________________________________
Phone number: ____________________After Hours:_________________________
Web Address of Organization: __________________________________________
Fax Number:__________________________________________________________
Address: _____________________________________________________________
_____________________________________________________________________
Email: _______________________________________________________________
Referred by: _______________________ Phone#: ___________________________

Request need to be submitted 2 weeks prior to the scheduled event:
Date Submitted: _____________ (Check one) Emailed: _________ Faxed: __________

Approved Photographer Credentials will need to provide a Disc of all photos to East Bay Raceway Park. I hereby grant East Bay Raceway Park to use my photographs in any and all publications, including web site, promotional material, etc. without payment or any other consideration of perpetuity. I hereby authorize East Bay Raceway Park to edit, alter, copy, exhibit, publish or distribute these photos. I agree not to sell photographs on East Bay Raceway Park property. ________ (Initial)

Which event/events will you be covering:
Date:______________________ Event: _________________________
Date:______________________ Event: _________________________

Did you cover the 2009 Winter Nationals? Yes / No (circle one)
If Yes please summit your photos or articles, of last years events with media request form.
We will notify you by email to confirm your credentials. Once approved if unable to attend please call our office to cancel credential request.
_____________________ _________________
Signature Date
Thank you for your interest in covering East Bay Raceway Park Events. We look
forward to working with you and your staff.
Thanks,
Todd Hutto
(fmscracing@aol.com)
Fax: 813 672-1901
Office: 813 677-7223
Media Credential Request