SIGN UP FORM

Nya’s Marathon Fundraiser Bounce

Sunday, June 28th 4pm-6pm

Southie Studio

To sign up, complete the form below and donate $5 here: go.barregroove.com/nya-marathon-donation

416 W Broadway, Suite 202, Boston, MA 02127

First Name

Last Name

Email Address

Phone Number

Address 1

Address 2

City

State

Zipcode / Postal Code

Country

Birthday

Day

Month

Year

SMS Notifications

By selecting this option, you agree to receive marketing communications via sms

Email Notifications

By selecting this option, you agree to receive marketing communications via email

Terms and Conditions

I agree to electronically signing the Terms of Service and Privacy Policy.