APPLY For Membership
Please fill out this form to apply to BLUE1647.

This helps us know how we can best provide value to you, and what value you will bring to the BLUE1647 / BLUE|Lacuna community.

After you submit this form, we will contact you within 1-2 business days.

When can you visit our Pilsen location if you have not before? *
First and Last Name *
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Email (this where we will contact you) *
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Phone *
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Your Gender *
Company or Organization Name *
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Company Website
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Number of members wanting to join? *
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Which of the following is most important to you when considering joining BLUE1647? *
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Tell us some information about yourself, or your company. (Include: Blog link, Accomplishments, School Attended and Degrees Earned, Current Employment Status, and Future Goals) *
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Linkedin page
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Twitter Handle
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How did you hear about BLUE|1647? *
Submitting your application signifies that you have read and agree to the brief terms below. *
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Submitting your application signifies that you have read and agree to the Privacy Policy linked here: http://bit.ly/1DNhMMx *
Select the membership level you're interested in. *
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