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info@thepishop.org
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BECOME A
MEMBER
CONFIDENTIAL APPLICATION FOR MEMBERSHIP
PLEASE COMPLETELY FILL OUT THE APPLICATION QUESTIONS BELOW. YOU CAN PROVIDE SUPPLEMENTAL INFORMATION OR EMAIL QUESTIONS TO:
Info@ThePiShop.org
.
I. ELIGIBILITY & NON-DISCRIMINATION
The Pi Shop (“Company”) encourages everyone to apply for membership and does not consider, apply, use or discriminate in the application process and approval because of an applicant’s sex, gender, sexual orientation, race, color, religious creed, marital status, ancestry, national origin, medical condition, age (over 40) or disability.
II. REQUIREMENTS
In the event an application is preliminarily approved for admission as a member, before using any facilities of the Company he or she must successfully complete a safety and security program and sign - on agreeing to abide by all Company policies (e.g. confidentiality & safety policies).
***All applicants will be charged a non-refundable $50 processing fee if submitted application is approved. This includes 1 background check. All additional background checks required will be charged an additional $25 each.
III. PERSONAL INFORMATION
First Name
*
Last Name
*
Phone Number
*
E-mail Address
*
Website URL
Upload Photo
Upload
Upload Photo
Upload
Address:
Street
City
State
Zip
Brief Personal History and Education
How Did You Hear About The Pi Shop
IV. PREFERRED TYPE OF MEMBERSHIP & FEATURES
Note: Membership types and adders subject to different fees and limited availability.
Membership Type Requested
Co-Work Space
Dedicated Office Space
Student Participant (Must be a current student)
Membership Adder(s) Requested
Incubator Program
Shop Access
On-site Storage
V. IDEA AND BUSINESS INFORMATION
Note: You may include sketches or drawings by emailing them to
Info@ThePiShop.org
Name of Product and/or Business
Confidential Disclosure of Product/Idea
Do You Have a Business Plan?
Yes
No
Have You Created a Business Yet?
Yes
No
What Form of Entity is Your Business?
Corporation
LLC
Sole Proprietorship
General Partnership
Limited Partnership
Other
When Did You First Conceive of the Idea?
When Did You First Disclose the Idea?
When Did You Form the Business?
How Would You Characterize the Stage of Your Idea, Product and/or Business (Check All That Apply)
Early Idea Phase (such as early drawings but no prototyping)
Early Development Phase (such as creating concept prototypes)
Developed & Assembled Team to Prototype
Raised Seed Money or Secured Other Funding for Product Development
Consulted with Engineers, Patent Attorneys and Other Professionals
Market-Ready Prototypes Done but Have Not Starting Manufacturing
Begun Limited Commercial Applications and Sales
Have at Least One Product on the Market but Look to Expand Versions
Have Established Manufacturing, Distribution & Marketing
N/A
Name
Role
Have You Identified Potential Intellectual Property?
Yes
No
Have You Filed Any Patents, Trademarks, Copyrights or Otherwise?
Yes
No
VI. MISCELLANEOUS QUESTIONS
Only fill in if you are not human
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