MakerSpace Equipment Membership Application Name(Required) First Last Today's Date(Required) MM slash DD slash YYYY Intended Start Date(Required) MM slash DD slash YYYY Phone(Required)Email(Required) Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country What type of work will you be doing with the Utility Works MakerSpace equipment?(Required) What equipment will you use the most at Utility Works MakerSpace? (check all that apply)(Required) 3D Printers Sublimation Printer Large Format / Banner Printer Vinyl Cutter Glowforge Heat press Software: ex. Cura, Blender, CAD (computer aided design) and adobe suite. Sewing Machine Embroidery Machine Tufting Gun What type of membership you would like? (choose one)(Required) Bronze (3 Day Visits: $40/month) Silver (7 Day Visits: $75/month) Gold (Unlimited Visits: $150/month) (Access and use of equipment is permitted only during office hours)Are you a college student? (must show student i.d.)(Required) Yes No Are you at least 18 years of age or older?(Required) Yes No (You must be at least 18 years or older to secure a membership at the Utility Works MakerSpace. If you are under the age of 18 you can purchase a junior membership, 20% discounted rates, that is attached to an adult membership, parent or guardian, who will be here with you at all times.)Does your work generate any noise, odor, dust or any other potential disturbances to other members?(Required) Yes No If yes, please describe:Will you be using our equipment for your business?(Required) Yes No If yes, please tell us about your business:Please list two references: (previous landlord, friend, coworker etc.)(Required)NamePhoneEmail Add RemoveEmergency Contact:(Required)NamePhoneEmail Add RemoveHow comfortable / proficient are you with the following equipment ?(please check one of the circles for each equipment so we have a better idea of how we can help.)3D Printers(Required) No experience Average experience Lots of experience Sublimation Printers(Required) No experience Average experience Lots of experience Large Format Printer(Required) No experience Average experience Lots of experience Vinyl Cutter(Required) No experience Average experience Lots of experience Glowforge(Required) No experience Average experience Lots of experience Heat Press(Required) No experience Average experience Lots of experience Software ( e.g. Cura, Blender, CAD and Adobe suite )(Required) No experience Average experience Lots of experience Embroidery / Sewing Machine(Required) No experience Average experience Lots of experience Tufting Gun(Required) No experience Average experience Lots of experience Application Fee(Required) Price: