Membership Application

Name: ______________________________________________

Desired username: ___________________________________

Twitter / Facebook: ___________________________________

Address: ____________________________________________

City / State / Zip: ______________________________________

Phone number: ______________________________________

Email address: _______________________________________

___ I have read and agreed to abide by the bylaws.

T-shirt size: ____________

Briefly state your main interest in joining Alpha One Labs:

_____________________________________________________

How many triangles are in this image? ____________

___ I would like to teach a class. Explain below:

_____________________________________________________

Liability waiver

___ I acknowledge that the space is dangerous.

___ I am personally responsible for my own safety and will respect the safety of others.

___ I will not hold Alpha One Labs or any of its directors accountable for any injury to myself.

___ I am competent to sign this waver.

Applicant Signature: _____________________ Date: _________

Regular Member [ ] $40/Month