Enrollment

Please print out form and bring with you to a race or mail in to address below. If you have any questions, please ask.

South Eastern VW Association Enrollment Form

Name:_________________________________________________________________________

Address:________________________________________________________________________

City:_______________________ State:______ Zip:________________

Phone:_____________________ Email:_________________________

Type of Race car___________class_________ car # ____________

Social Security # ___________________________________(to be used for 1099s if you earn $600 or more)

Dues are $25 a year, which include 2 stickers, & monthly emails and/or mail outs.

Paypal fees to sevwa@sevwa.com (please add 2.5% of total to cover paypal service fees) subject: SEVWA membership

Please make checks payable to K & L Motorsports and send to: 450 Oak Trace Rd, Hahira, GA 31632

Kathy Jacobs 919-616-2183 Or Keith Bumgarner 919-616-1039