ULTRA4 Racing Media application and release
King of France 2017
MEDIA OUTLETS MUST COMPLETE THIS FORM IN ENTIRETY
PLEASE NOTE: The submission of this form does NOT guarantee a media credential.
Submission must include media waiver to be complete.
ALL Media must wear a safety vest at all times while on race course. Vests are available on site at media check in and a deposit of £20/€20 will be taken.
Name: ______
Media Outlet: ______
Address: ______
County: ______Post Code: ______Phone: ______Fax: ______
Email: ______Website: ______
Track Access Requested: ______Place an asterisk* next to names requesting track access.
MEDIA TYPE QUANTITY CREDENTIAL NAMES____
STILL PHOTOGRAPHER ______
BROADCAST CREW ______
PRINT REPORTER ______
RADIO PRODUCER/REPORTER ______
INTERNET REPORTER ______
Interviews Requested: ______
Date(s) Coverage Will Break: ______
OUTLETS RECEIVING CREDENTIALS ARE ASKED TO PROVIDE COPIES OF All MEDIA COVERAGE
Breaking media coverage should be emailed to
Photographers/Videographers please supply post race: Digital link or disc with samples of photos and/or video
Magazines/Newspapers please supply post race: Print date/newsstand date. Link to article where applicable or PDF copy of coverage
TV/Broadcast/Radio Please supply post race: Date coverage aired. Radio - audio file/MP3. TV – video clip
Online Coverage Only please supply post race: Link to actual coverage or screen grab of coverage.
Additional waivers may be attached. One for each credential please.
By completing this form, I hereby apply to Ultra4 Europe Limited, to participate as a credentialed media representative in the above selected 2015 ULTRA4 Europe Racing events. By my signature below, I certify that I have read, and understand, and accept the following representations, stipulations, and waivers.
I understand that Ultra4 Europe Limited and/or, their lessees, agents, directors, officers, servants, employees, volunteers and co-promoters if any, will not accept financial or legal liability for any injury, physical damage or other occurrence arising from the event or activities of the above persons. Accordingly, my participation in such event and activities shall be at my own risk.
I waive all rights to the use of my name, and likeness of myself, or equipment for entertainment, or commercial promotional uses.
Accordingly, I forever release, discharge and waive, for myself, my personal representative, heirs, and next of kin, all claims which I might have against Ultra4 Europe Limited and/or the property owners, their agents, directors, offices, servants, volunteers or representatives, for and from any injury, accident, illness, property damage, death or other occurrences arising in any manner whatsoever which is caused by or arises out of my participation in this event. I expressly assume all risk of my participation including the risk that I might be injured or die as a result of the negligence or gross negligence of Ultra4 Europe Limited or others who are under their direct and indirect control.
I expressly assume financial and/or legal liability for all risks or injury to persons who accompany me to this event including my family members, guests, friends, and acquaintances, and all other persons who accompany me in my registered vehicle. Furthermore, I agree to indemnify, save and hold harmless Ultra4 Europe Limited and/or the property owners, or their agents, directors, officers, servants, employees, volunteers, and lessees, from all risks assumed above and any damage to personal property or personal injury caused by others.
In consideration for award of this media credential I acknowledge and agree as follows: Ultra4 Europe Limited shall have the right, throughout the universe, in perpetuity, free of charge, a license to employ before I make it available all footage in any video/film, any and all audio-visual devices and other derivatives and reproductions thereof, and any and all related still and motion pictures for advertising and promotional materials, and to, exhibit, broadcast, distribute, sell, rent, and otherwise use and exploit the film by any and all means, in any medium or form, whether now or hereafter known, either alone or coupled with other materials. Ultra4 Europe Limited shall have the right (but not the obligation) throughout the universe, in perpetuity, to use my name and likeness in connection with any use or exploitation of the film I warrant and represent that I have the right to grant the rights granted hereunder, and I shall indemnify Ultra4 Europe Limited for any damages incurred as a result of any breach of my warranties, representations and agreements hereunder. The undersigned acknowledges that it has read and understands the foregoing, and that upon signing its name below, this document shall become legally binding.
Waiver must be signed by all Media liaisons, or any other persons who will physically present themselves on the event track within the restricted area.
Date: ______Signature ______
Print Name ______
Address ______
City & County ______
Phone number______
Email Address______
Media outlet______
Please scan and email all media credential applications to Kerry Eades at .
Kerry can be reached at +447572441870 with any questions or concerns.
(Signatures required of media participant.)
rev. 2.2011.