First Name: *

Last Name: *

Phone Number: *

Email Address: *

Mailing Address:

What brings you to the Hackerspace? How did you learn about us? What are you interested in doing?

How frequently do you plan to attend the Hackerspace?

What is your desired membership level? * (Most members choose the Standard Tier.)

Emergency Contact:

Emergency Contact Phone Number:

Emergency Contact Relationship:

Do you have any medical conditions that may effect your ability to safely operate machinery? If so, please describe:

Please read the liability waiver and sign this form by typing your name into the textbox below to indicate that you agree. *

I, the undersigned, confirm that the information here is true, correct, and accurate, and I promise to be excellent to people. By signing this WAIVER AND RELEASE I assume any risk and take full responsibility and waive any claims to personal injury, death, or damage to my person and personal property associated with Santa Barbara Hackerspace, Inc. I understand and confirm that by signing this WAIVER AND RELEASE I give up considerable legal rights. I am signing this agreement freely, voluntarily, and under no duress. My signature is proof of my intention to execute a complete and unconditional WAIVER AND RELEASE to the full extent of the law. I am 18 years of age or older and mentally competent to enter into this waiver, or I am the parent or legal guardian of a minor and entering into this agreement on the minor’s behalf.

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