Editing Membership Application

'''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

[[Category:Membership]]