Refraction Membership Application

Welcome! We are excited to learn more about you and your organization.

Name

Title

Email

Phone

Company Name

Company Headquarters

Company Size

Industry

URL

I have completed a tour of the space

Membership Type

Number of Private Team Rooms requested

Number of Coworking Desks requested

Community Involvement
Our members are active and respected members of their communities. We ask that new members detail their professional membership or community association details below.

Mava (Pitched at CapCon or Techbuzz)

Mindshare Alumni

Co-working community (1776, Fishbowl, Uber, Co.Work etc)

Other Association

How did you hear about Refraction?

Do you know anyone who is already a member of our community?

Culture & Collaboration
In our member organizations we look for a cultural fit and those interested in shaping as well as benefiting from our growing community.

How do you hope to benefit from the community?

How do you hope to contribute to the community?

If you were to give a 15 min talk/pitch to educate our broader community, what expertise would you share?

Which of the following programs are you interested in participating in?
Check as many as appropriate.

Employee Engagement

Leadership

Social Responsibility

Talent Acquisition & Retention

Wellness

Which of the following Meetups would you or your team be interested in regularly attending?
Check as many as appropriate.

Design/UX

Development

Marketing

Sales

Other Suggestions

What are the 3 greatest challenges you face in the coming 12 months?

What are the things you need most to take your company to the next level?

Thank You.
Thank you for taking the time to complete our application, we appreciate your diligence. We will review and get back to you with your fit and next steps. If you have any queries at all please reach out to the team via Hello@refractionpoint.org or reach out to Rae, Nick or Jordan directly.

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