The Connecticut Breakout
Interest Form
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
How Are You Interested?
Participant (I’d like to race)
Sponsor / Partner
Marine Industry Professional
Media / Press
General Interest / Supporter
Volunteer (help run the event)
What type of boat or propulsion system would you race?
Company / Organization Name
Business or role in the industry
Engagement Level
Just curious / want updates
Likely to participate or support
Very committed (ready to sign up when possible)
How did you hear about The Connecticut Breakout?
Please Select
Friend / Word of Mouth
News / Media
Social Media
Other
Would you support the project through a digital membership / NFT?
Please Select
Yes
No
Unsure
Interested in future merchandise (T-shirts, hats, etc.)?
Please Select
Yes
No
Unsure
Opt-Ins
Yes, I’d like to receive updates about The Connecticut Breakout
Recognize me publicly as a Founding Supporter (website / NFT perk)
Join the Crew
Should be Empty: