Full Name
Email
Membership Type Day PassIndividualFamilyLibrary Pass
I am under 18 Parent or guardian's email
Corporate: level
If Family was chosen above, list all members. Full Name Email Phone Date of Birth
Full Name Email Phone Date of Birth
Driver's License Number
Date of Birth
Mailing Address
Phone Number
I am or was an active member of the US Military or Reserves
How did you hear about the Powell MakerSpace Word of MouthWalked byFacebookPowell TribuneBasin RebootOther (Specify)
Membership Agreement General Policies and Procedures
I have read and agree to the Membership Agreement I have read and agree to the General Policies and Procedures