The Brave Technology Co-op will be run by its members and we are delighted that you would like to join us to build, cooperatively, technology to combat the overdose epidemic.

We need the answers to all of the following questions in order to register you as a member.

We will confirm your membership as soon as possible.
What is your first name? *

What is your last name? *

Please share any middle names with us too.

What is your address? (Please include postal code, city and country.) *

What is your place of birth? *

What is your date of birth? *

Please specify which of the following types of member you expect to be. *

It is common for co-ops to require members to pay a one-off or recurring fee, please indicate which of the following statements you agree with most closely:

Thank you so much for your application. We are in the process of reviewing all applications and will be accepting members in batches. You will hear from us as soon as we start processing memberships.

Thanks for completing this typeform
Now create your own — it's free, easy, & beautiful
Create a <strong>typeform</strong>
Powered by Typeform