HQ Raleigh Member Application 2017
I am joining the HQ community to become a member of the community. We are entrepreneurs looking to empower others, create businesses that are purpose driven and leave the world better than we found it. We envision a future where individuals and companies will take courageous and mindful action to drive positive change.

As part of the community I understand that it is my responsibility to maintain and foster these 6 HQ Core Values.

1.Be Authentic
2.Empower Others
3.Drive Forward with Purpose
4.Think Big!
5.Leave the World Better than you Found it
6. Embrace Diversity

After reviewing the Core Values, please select a response *
How do you identify? *
Full Name *
Your answer
Email Address *
Your answer
Phone Number *
Your answer
Company Name *
Your answer
Company Website
Your answer
Job Title
Your answer
Company Industry *
If Other, please describe
Your answer
Please describe your company and your position *
Please include product or service offerings, your company's strategic vision, whether you work full-time, when you began this position, whether you have funding, and any other pertinent information
Your answer
Why are you interested in joining HQ Raleigh? *
Your answer
What do you think you can contribute to the HQ Raleigh community? *
Your answer
If you have coworkers or employees, are they interested in joining HQ Raleigh? If so, how many memberships are you interested in? *
Your answer
Desired membership level: *
When would you like to start renting
Referred by: *
If Other please specify
Your answer
Any Questions or Comments?
Are there any special considerations we should know about in regards to the type of space your company needs.
Your answer
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