Membership Application
Please complete the sections below. If you have questions please contact membership@hackermoms.org
Email address *
What's your name? *
Your answer
Preferred Pronoun
Address or just your city: *
Your answer
What's your email? *
Your answer
Best way to contact you: *
Email, phone # or text.
Your answer
Do you have a website?
If Yes, add URL below:
Your answer
Occupation/Company?
Your answer
How did you hear about Mothership HackerMoms? *
Required
Please elaborate on your answer above.
i.e., if you heard about us from a member, who was it? Where did you see the flyer? Which newspaper or online article? etc.
Your answer
Did you attend one of our Open Houses? *
Required
Tell us a bit about you, your projects, & why you're interested in HackerMoms? *
Your answer
Kid(s) name(s) and age(s): *
Your answer
Kid's known issues (allergies, health, etc.)? *
Your answer
Let us know who else thinks you're fabulous! Please list 3 references. Include their name, contact info and your relationship to them. *
Please list someone who knows you and your kid(s) well. Maybe your BFF from school, close co-worker, mentor or mentee, favorite neighbor, etc. Email is preferred.
Your answer
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