NWLA Makerspace Member Application
Email address *
First Name *
Your answer
Last Name *
Your answer
Age (ages 18+) *
Your answer
Address *
Your answer
City/Town *
Your answer
State *
Your answer
Zip *
Your answer
Phone number *
Your answer
Social Media URLs (twitter, facebook, website, etc.)
Your answer
Occupation
Your answer
Emergency Information
Preferred Hospital *
Your answer
Emergency Contact #1 Name *
Your answer
Emergency Contact #1 Phone Number *
Your answer
Emergency Contact #2 Name *
Your answer
Emergency Contact #2 Phone Number *
Your answer
Tell us more about the specific ways you would like to be involved in our maker community. Please include the type of class that you would like to teach and times that you are available to teach if applicable.
Your answer
What would you like to see in the Makerspace (ex: tools, workshops, equipment, software, etc.) Please be specific
Your answer
About Me
Please check all that apply.
If you checked box #1 or #2 in the About Me section above, please fill out this section
Name of Business/Organization I work for
Your answer
My Role at this business
Your answer
Types of products I will be making using NWLA Makerspace resources
Your answer
Please select your Membership Type (an invoice will be sent to the email listed above.) ***Fees subject to change *
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