Wufoo
OurSpace Fort Wayne
Name
*
First
Last
Phone Number (Best Number to Reach You)
*
###
-
###
-
####
E-Mail
*
Occupation/Hobby
*
Technologist
Graphic Designer
Consultant
Writer
Artist
Other
What will your furniture and equipment needs be?
*
Cubical and Chair
Laptop Table and Stool
Artist Table
Other
Other
How often will you work from OurSpace?
*
7 days per week
5 days per week
2 to 3 days per week
Once a week
2 to 3 times a month
Once a month
Less than once a month
I'm ready to discuss membership options
*
Immediately
6 - 12 months
12 - 18 months
Unsure
3 to 6 months
I'm interested in the following membership option:
Daily Jo/Joe
Weekender
Moonlighter
Flexible Flyer
Regular Joe/Jo
Workaholic Joe/Jo
Comments or Questions:
Do Not Fill This Out
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