Membership Application
Candidate Member Information
Your Information - Not Public
The information that you provide is confidential. Melbourne Makerspace will not make public any of your information from this section.
First Name *
Your first name as it appears on your photo ID card.
Your answer
Last Name *
Your last name as it appears on your photo ID card.
Your answer
Year Of Birth *
Select the year that you were born, you must be at least 15 years old. If born prior to 1950 select 1950.
Phone Number *
Enter your phone number where you may be reached. 123-456-7890 International numbers not supported.
Your answer
Cell Phone or Land Line *
Does this phone send and receive text messages?
Email Address *
Enter your email address.
Your answer
Address - Why We Ask
We ask for your residential address. We require it for emergency purposes and billing verification. Melbourne Makerspace does not send mail to its members. We do not release this information to the public or other members. Access is limited to Melbourne Makerspace managers. We do not sell it to mailing list companies. You will be asked to verify your address by displaying your state or federal government issued identification document when you become a member. International members are required to provide a local physical address.
Address - House Number *
Enter the number portion of your street address. Street name asked in next question
Your answer
Address - Street *
Enter the name of your street without the house number or apartment number. Include St. or Dr. ,...
Your answer
Address - Apartment
If you have a unit ID, enter it here (A, B, 277, 3209...)
Your answer
Address - City *
Enter the name of your city or town. As defined by your mail address.
Your answer
Address - State *
Enter the two (2) letter state. If not part of US select "Other not US"
Address - Zip *
Enter your zip code. Five (5) numeric digits. No spaces or special characters.
Your answer
EMERGENCY CONTACT
Who should we contact in case of emergency. By providing this information you authorize us to communicate with them and release information in an effort to render assistance to you. The information that you provide is confidential. Melbourne Makerspace will not make public any of your information from this section.
Emergency - Name
Enter the first and last name of who we should contact in an emergency.
Your answer
Emergency - Address
Enter the full street address of the emergency contact
Your answer
Emergency - Phone
Enter the phone number of the emergency contact in the form NNN-NNN-NNNN
Your answer
Emergency - Email
Enter the email address of your emergency contact.
Your answer
Public Information
In this section we ask you questions about your skills, knowledge, likes and intent. All answers are optional. This information will be shared with Melbourne Makerspace members.
Public - Profession
Enter a short description of your current profession. If not working, so state and provide a description of what you are looking for. It is possible that a member is looking to hire people.
Your answer
Public - Skills
Select the skills that you feel competent at.
Public - Skills Detailed
Tell us about any specific skills or knowledge that would be of interest or benefit to you or the other members.
Your answer
Public - Goal
Tell us why you want to become a member. What types of activities are you interested in. Do you have a specific thing you intend to accomplish
Your answer
Public - Activities
Tell of if you are interested in being involved in Melbourne Makerspace activities.
Public - How did you hear about us?
Please tell us how you came to know about Melbourne Makerspace.
Your answer
Public - Social Media Accounts
If you have any social media accounts (LinkedIn, FaceBook...), please share the link to them.
Your answer
Terms and Conditions
By agreeing to the stated terms and entering your signature below you apply to become a member of MELBOURNE MAKERSPACE, INC. 401 N.Wickham Rd. #135 Melbourne Florida 32935
Terms and Conditions - Release of Liability *
I fully assumes all risks associated with participation in events and exempts and releases Melbourne Makerspace, Inc., its members, officers, agents, board members, from any action whatsoever arising out of any damage, loss or injury to the participant or the participant’s property while upon the premises or using any equipment of the organization or while participating in any of the activities contemplated by this agreement whether such loss, damage, or injury results from the negligence of the corporation, its members, agents, or other causes.
Terms and Conditions - Assumption Of Risk *
I acknowledges that inherent risks, dangers and hazards exist when using power tools commonly used in electronics construction, fabrication, software design and other technology related activities. Participation in such activities and/or the use of equipment associated with technology design, manufacture and experimentation may result in injury, illness, death or damage to personal property. These risks and dangers may be caused by other members or guests, by accidents, acts of nature or other causes. Risks and dangers may arise from foreseeable or unforeseeable causes including, but not limited to electrocution, burns, impalement, injury from slips or falls, etc.
Terms and Conditions - Covenant Not To Sue *
I agree never to institute any suit or action at law otherwise against Melbourne Makerspace, Inc., its members, officers, board members, agents, nor to initiate or any way assist the prosecution of any claim for damages or course of action which I, my heirs, executors or administrators hereafter may have by reason of injury to the person of the member or to the participant’s property arising from the activities contemplated by this agreement.
Terms and Conditions - Third Party Indemnification *
I indemnify, save and hold harmless Melbourne Makerspace, Inc., its members, officers, board members, or agents from any and all losses, claims, actions, or proceedings of every kind and character which may be presented or initiated by any other persons or organizations and which arise directly or indirectly from the actions of the member while engaged in the activities contemplated by this agreement.
Terms and Conditions - Video Audio Photo Release *
Melbourne Makerspace provides video and audio monitoring of its facilities and surrounding areas. We allow the general public to view these camera feeds in real time. Classes are recorded and published on YouTube. You agree to the usage of this material.
Terms and Conditions - Acknowledgement *
I hereby acknowledge that I have CAREFULLY read all of the provisions above, fully understand the terms and conditions expressed there, and do freely choose acceptance of the provisions of the foregoing paragraphs relating to assumption of risk, release of liability, covenant not to sue, and third party indemnification.
Application - Signature *
By entering my signature I apply for membership in Melbourne Makerspace. Format for the signature is: "<SIGNATURE><your-name-as-you-sign-it>". The usage of the < and > characters around the text SIGNATURE is required. Text size of your signature between the < and the > is 6 to 25 characters. EXAMPLE: <SIGNATURE><John B. Doe>
Your answer
Application - Next Activity
After you press submit, you will receive an email confirming your application. Your next activity will be to attend three (3) events on different days at Melbourne Makerspace. This is required. On your third time attending, your application will continue to be processed. Your identification must be presented and verified as the same as on the application. Your membership dues are expected at or before that time. Access information and devices will be issued after application approved and 1st month dues are collected. Dues must be paid on line at: http://melbournemakerspace.org/contact/ use the Automatic Billing button.


IMPORTANT: Your dues payment(s) must reference your name as it appears in this application form.

Application - Suggestion(s)
If you have any problems with this form, please email us at admin@MelbourneMakerspace.org
Application - Comments
Your comments about this application form are invited. Too long, too short, ask this, don't ask that. What ever you think should change.
Your answer
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