LRTC Membership Interest Form

Thank you for your interest in the Lafayette Regional Technology Council (LRTC)!

We are a new organization dedicated to fostering a thriving tech ecosystem in our region through knowledge sharing, talent development, regional marketing, and policy advocacy.

Please take a few moments to share your interests and needs so we can build an organization that best serves our community.

Are you filling out this form on behalf of your company, or yourself as an individual?

Name

First NameLast Name

Email

example@example.com

Your Company Name

Your Role / Title

Where are you located?

How is technology used in your daily work?

What is your area of technical expertise or interest? (e.g., software development, data science, cybersecurity, IT management, design, etc.)

How many years of experience do you have in the tech industry or a tech-related field?

What are your primary interests in joining the LRTC? (Select all that apply)

Other

What types of events or activities would you be most interested in participating in? (Select all that apply)

Are you currently affiliated with any other organizations, programs, or networks that support or relate to the tech industry or your career in tech (e.g., professional associations, industry groups, meetups, accelerators, academic or workforce programs)? If so, please list them below.

Your Name

First NameLast Name

Email

example@example.com

Company Name

Company Website

Address of primary headquarters:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Number of Employees:

Years in Operation:

What is your company's primary industry focus within the tech sector? (e.g., software development, biotechnology, advanced manufacturing tech, digital media, etc.)

How does your company utilize technology in its operations and/or offerings?

Briefly describe your company's primary products and/or services:

What are some of the biggest challenges your company currently faces related to technology, talent, or growth in the region?

What are your company's primary goals for joining the LRTC? (Select all that apply)

Other

What types of engagement would your company be most interested in? (Select all that apply)

Other

Is your organization currently affiliated with any other organizations, programs, or networks that support or relate to the tech industry or development of tech talent (e.g., professional associations, industry groups, meetups, accelerators, academic or workforce programs)? If so, please list them below.

Name of Designated LRTC Representative:

First NameLast Name

Title of Designated LRTC Representative:

Email of Designated LRTC Representative:

example@example.com

Designated LRTC Representative refers to the individual within your organization that should be the point of contact for LRTC related communications, invitations for your company & employees to participate in LRTC initiatives, etc.