LRTC Membership Interest Form

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?*

IndividualCompany
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)*

Networking and knowledge sharing with experienced professionalsConnecting with startups and emerging talentParticipating in initiatives to attract, retain, and develop tech talentContributing to the marketing of our region as a tech hubParticipating in initiatives to attract, retain, and develop tech talentSupporting advocacy for pro-tech policiesOther
What types of events or activities would you be most interested in participating in? (Select all that apply)*

Workshops and training sessionsNetworking eventsMentorship opportunitiesIndustry-specific discussionsAdvocacy effortsSocial gatheringsOther
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)*

Accessing knowledge and best practices from other tech companiesSharing expertise and mentoring startupsParticipating in talent recruitment and development initiativesContributing to the promotion of our region as a tech hubSupporting advocacy for policies that benefit the tech industryNetworking with other tech companies and professionalsIdentifying potential partnerships or collaborationsOther
What types of engagement would your company be most interested in? (Select all that apply)*

Sponsoring events or initiativesParticipating in mentorship programsHosting workshops or presentationsContributing to advocacy effortsOffering internships or job opportunitiesCollaborating on regional marketing campaignsOther
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.
Should be Empty: