Name *

First Name

Last Name

Cell Phone *

(###)

###

####

If this is a reoccurring class, how often?

Daily

Weekly

Monthly

5 Classes

10 Classes

What type of activities would you like? *

Group Stand-Up Paddleboard Lesson (13 and up)

Social Paddle (kids welcome)

Sunset Paddle

Birthday Party

Bachelor/Bachelorette Party

Family Reunion

Other, please specify below

What is the ideal date for your event?

Please choose a date you'd like to have your event, I can not guarantee it will be available but we will start there.

MM

DD

YYYY

What time would you like your event to being?

Hour

Minute

Second

AM PM

Would you like to use Long Island Vibes' East Moriches, NY location? *

full address given upon registration

Yes

No, I have another location in mind, please specify below

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country