Membership Application

From Alpha One Labs

Name: ______________________________________________

Desired username: ___________________________________

Address: ____________________________________________

City / State / Zip: ______________________________________

Phone number: ______________________________________

Email address: _______________________________________

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

___ I have signed the Liability Waiver.

My preferred time to be at the space is:

_________ (day(s) of week) at _______________ (time(s))

T-shirt size: ____________

Briefly state your main interest in joining Alpha One Labs:

_____________________________________________________

_____________________________________________________

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

_____________________________________________________

_____________________________________________________

Applicant Signature: _____________________ Date: _________

Regular Member [ ] $40/Month - Key Deposit [ ] $15