Membership Application Thank you for your interest in a membership to the Madison Circus Space. If you haven’t yet, please review the information on the membership information page and the policies and guidelines page. Applicant InformationName(Required) First Last Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone(Required)Email(Required) What type of membership are you applying for?(Required) Ground Aerial Wheel DisciplinesWhat are your primary circus or movement arts?(Required) Aerial German wheel Cyr wheel Juggling Hooping/Flow Acro Slackline Unicycle Dance Flying trapeze Other Select all that applyOther Wheel MembershipDescribe your experience level.(Required)Give some examples of skills you plan to practice with your membership.(Required)What are some skills you are working on now? What are some skills you would like to learn in the future?(Required)What is your plan to learn and practice those future skills safely?(Required)What is your plan to maintain a safe practice with the skills you are regularly doing now?(Required)Please add any other information you think is relevant.(Required)Aerial Membership QuestionsAre you at least 18 years old?(Required) Yes No Are you currently a member at the Madison Circus Space?(Required) Yes No How long have you been consistently practicing aerial arts?(Required)Please specify the number of months in which you have worked 2-3 times per week on each individual apparatus (i.e. 28 months on lyra, 30 months on silks, and 6 months on single-point trapeze). How often are you currently training on aerial apparatuses?(Required) How often do you practice outside of an instructor-led class?(Required) Do you have any aerial performance experience? If available, please include a link to a representative video from your performances.(Required)What type of equipment do you have sufficient training in to safely lead a self-practice?(Required)E.g. silks, trapeze, lyra, etcWhen did you purchase your equipment and what is your process for maintaining and inspecting your equipment?(Required) Please detail your knowledge and experience with rigging. Have you participated in any rigging workshops or classes?(Required) All aerial members must have experience with rigging, maintaining, and inspecting their equipment.Will you help build the MCS community's culture of safety and think of the entire aerial community before or while you make decisions regarding your own or someone else's safety? Yes No In brief, what are your goals for aerial arts and how can an MCS membership help you achieve those goals?(Required)
