Media Credential Request

County Line Raceway
2014 Media Credential Request

**Requests Must Be Submitted In Writing, No Later Than 2 Weeks Prior To Event.**

Your Name (required)

Name of Organization/Affiliate

Your Title

Phone Number

Your Email (required)

Event You Wish To Cover

I hereby certify that I am an independent contractor, assuming all responsibility for myself as a result of participation in County Line Raceway events. I am not an employee, servant, or agent of County Line Raceway. I hereby agree to abide by all rules and regulation of County Line Raceway.

I will provide County Line Raceway with a disc of all photos taken and hereby grant County Line Raceway permission to use my photographs in any and all publications, including web site, social media, promotional material, and any other media without payment or any other consideration of perpetuity.

The undersigned understands that a race car exposes him/her to risks that can lead to serious bodily injury or death. By signing below, the undersigned voluntarily assumes these risks.

I Agree to the Terms Above (Type Name)

Thank you for your interest in covering event(s) at County Line Raceway. Our team will review your request and respond by phone or email the status of your request. Should you have any questions, please email Steve Summerlin (Public Relations Director) at steves@countylineracewaync.com.

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