Pre-Registration

Name: _____________________________________________

Address: ___________________________________________

City:___________________ State: ____ Zip: ______________

Vehicle Information

Year: ______

Make: ______________________________

Model: ______________________________

Southeastshowdown, Anderson Motor Speedway, City of Anderson, SC or anyone involved with
this event can not be responsible for any accidents or damage to vehicles, contestants or spectators.

Signature: _________________________ Date: ____________

Email Address: ______________________________________

Entry fees (includes driver and passenger):
Pre-registration:
$20 before July 15, 2013
$30 after July 15, 2013

Money orders ONLY Total enclosed: ______________

Return to:
  Jon Fulmer
106 Guest Circle
Anderson, SC 29621