First Name
Last Name
Email
*
Phone
*
Company/Organization Name
*
What Best Describes You?
*
Startup
Corporation
Founder
Tech Enthusiast
Brief Description Of Your Company / Venture (2–3 sentences):
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What Industry Best Describes Your Company / Venture?
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What Type Of Membership Are You Interested in?
Coworking Desk
Private Office
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How Many Team Members Will Actively Use The Membership:
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1
2
3
4
5
6
7
8
9
10 or more
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How Frequently Do You Anticipate Utilizing The Space?
Daily
Weekly
Occasionally
Virtual Only
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What Resources Would Most Enhance Your Experience? (check all that apply):
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Collaborative Innovative Environment
Skill-Building Workshops
Personalized Mentorship
High-Impact Networking Opportunities
Emerging Technology Access
Strategic Corporate Partnerships
How Do You See Yourself Contributing To The Levan Center Ecosystem?
*
How Did You Hear About Us?
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