MEDIA REQUEST FORM

Name *
Name
Address *
Address
Phone *
Phone
Name and Titles for credentials. Include production crew if possible.
The undersigned acknowledges and agrees that any photographs, video or other forms of media captured at the event for which credentials are being issued are to be used for news and editorial purposes only. Freelance journalists and photographers must provide proof of assignment along with this form to be considered for accreditation, and they may only use images for such assignment. Any sale of, or attempt to sell, commercially or otherwise, photographs, video or other forms of media captured at event for which this credential is presented is expressly prohibited without the prior written consent of Boot Barn Hall at Bourbon Brothers.
Full Name for Signature *
Full Name for Signature
Date *
Date
My submission is an acknowledgement that I have reviewed and am agreeing to these terms & conditions for credential on behalf of myself and the company and all individuals listed above.