Name of Organization
*
Physical Address of Organization
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Organization Email Address
*
Your Name
*
First Name
Last Name
What is your role at your organization?
*
Your phone number
*
(###)
###
####
Are you the main point of contact at your organization for Nation of Makers' membership?
*
Yes
No
If you answered "no" to the question above, who is the main point of contact at your organization for Nation of Makers' membership, and what is their email address and phone number?
What is your preferred method of contact?
*
Email
Phone
Other
If you chose "Other" above, please enter your preferred method of contact here:
What type of membership are you applying for?
*
Small grassroots community-based non-profit and for-profit startup membership - $50/mth ($600 annually)
Large community-based organization membership - $100/mth ($1,200 annually)
Library or Museum membership - $25/mth ($300 annually)
Small corporate membership ($5,000 annually)
Large corporate membership ($10,000 annually)
Federal, State, or Local Agency membership
Do you need to complete the financial hardship application?
*
Yes
No
How would you prefer to pay your membership dues?
*
Credit Card
Electronic Funds Transfer
Purchase Order
Check
Other
If you chose "Other" above, please enter your preferred method of payment here:
How frequently do you want to pay membership dues?
*
Monthly
Annually
Every two years (Members who elect to join for a two-year period receive an up-front 10% discount on membership dues paid in full)
What is the main function of your organization?
*
Makerspace
Hackerspace
Biospace
Fab Lab
Educational Facility
Library
Museum
Mobile lab
STEAM / STEM / Afterschool Program
Maker Event
Maker Support Organization (Hub, Resource Service)
Corporation
Trade Organization
Government Agency or Unit
Non-Governmental Organization (NGO)
Other
If you chose "Other" above, please describe your organization's main function here:
Is your organization open to the public?
*
Yes
Yes, for a cost
No
Other
If you chose "Other" above, please explain further here:
What ages does your organization serve? Select all that apply.
*
1-5
6-10
11-14
15-17
18-20
21-30
31-40
40-65
65+
Our organization has:
*
No tools at all (community hubs, software incubators, etc)
Hand tools, maybe household 3D printers, etc
Average makerspace/fab lab equipment
Advanced prototyping capabilities (capable of dedicating machines to productions of small runs)
Complex machinery capable of manufacturing 1,000+ units
How did you hear about Nation of Makers?
What is the membership feature that you are most excited about?
Is there anything specific that Nation of Makers can help your organization with immediately?