Big Bug Shootout  Registration Form

Please print and completely fill out form below and mark appropriate boxes. 

Print out and bring with you to the event or send us an email at info@sevwa.com with the following information. Info needs to be sent by Friday 9pm. Otherwise, wait until show day. Pay day of event at the registration table.

Name:_______________________________________________________
Address:_____________________________________________________
City,State & Zip:________________ _______________________________

Phone #_______________ E-Mail:_________________________________
Model, Year, color: _____________________________________________

Class Choice:_________Race class & car #:____________________     

Club Affiliation:_________________________________________

Show cars:       $10(doesn't include gate fee)

Bracket Race Cars:_____SP $35 ___ Pro $30 ____ Sportsman $25 (doesn't include gate fee)

Vendors:

___Used Parts $30(1 gate included) ____ Toy/T-shirt/sticker $50(1 gate included)   ____New Parts $75 (1 gate included)                

Please make check or money order payable & send to: K & L Motorsports 450 Oak Trace Rd., Hahira, Ga 31632

Paypal to sevwa@sevwa.com (please add 1.25, to cover paypal service fees) Subject: Big Bug Shootout

Please specify the class you feel you belong in. Event officials reserve the right to re-classify your VW at the time of entry. No class changes after your car leaves the registration table. All registration forms must be signed! The undersigned hereby waives any claims against SEVWA/ K & L Motorsports LLC /Piedmont Dragway volunteers, sponsors, property owners and their representatives from any liability, personal injury, damages, or any other loss incurred as a result of the undersigned's participation in the Big Bug Shootout  #5 voluntarily and totally at his/her own risk. Unsigned applications not accepted.

Signature:__________________________________________________

Date:___________ email:_________________________

Any Questions? Call or e-mail us!  Kathy Jacobs 229-896-4957  Keith Bumgarner 919-616-1039