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Submitted URL: https://mail.1871.com/e3t/Ctc/ON+113/cpCDm04/VWRBQl5S0Y56W57rjbX74_dG3W6D6W6y5c4NCdN1RGL-Y3lYMRW7lCdLW6lZ3l3N2-B3KJNHp...
Effective URL: https://share.hsforms.com/16VQKR0SNTFy8M_ku4BithQ20ww1?utm_medium=email&_hsmi=299706821&_hsenc=p2ANqtz-99AAgU58mzukXkbJMbK...
Submission Tags: urlscan
Submission: On March 26 via api from US — Scanned from DE
Effective URL: https://share.hsforms.com/16VQKR0SNTFy8M_ku4BithQ20ww1?utm_medium=email&_hsmi=299706821&_hsenc=p2ANqtz-99AAgU58mzukXkbJMbK...
Submission Tags: urlscan
Submission: On March 26 via api from US — Scanned from DE
Form analysis 1 forms found in the DOM
<form id="hs-form-e9540a47-448d-4c5c-bc33-f92ee018ad85-f10e37a0-c87d-4eed-ba6d-4d60681abcdc" class="hs-form-e9540a47-448d-4c5c-bc33-f92ee018ad85 hs-form hs-form_theme-canvas" data-instance-id="f10e37a0-c87d-4eed-ba6d-4d60681abcdc"
data-form-id="e9540a47-448d-4c5c-bc33-f92ee018ad85" data-portal-id="3401857" lang="en" data-test-id="hs-form-e9540a47-448d-4c5c-bc33-f92ee018ad85-f10e37a0-c87d-4eed-ba6d-4d60681abcdc" data-hs-cf-bound="true">
<div class="hs-form__pagination-content-container">
<div class="hs-form__row">
<div class="hs-form__group">
<div data-hsfc-id="RichText" style="font-size: 14px; color: rgb(51, 71, 91);"><img src="https://3401857.fs1.hubspotusercontent-na1.net/hubfs/3401857/1871-DC-brandAssetsPlateLogo_plateLogoGunmetal%20(3).png"
style="max-width: 100%; max-height: 100%; display:block; margin-left:auto; margin-right:auto;" data-img-aspect-ratio="1.6587615283267456" alt="1871-DC-brandAssetsPlateLogo_plateLogoGunmetal (3)" width="100" data-img-width="100"
data-img-height="60"></div>
</div>
</div>
<div class="hs-form__row">
<div class="hs-form__group">
<div data-hsfc-id="RichText" style="font-size: 14px; color: rgb(51, 71, 91);">
<h1 style="text-align: center;">Member Spotlight Intake Form</h1>
</div>
</div>
</div>
<div class="hs-form__row">
<div class="hs-form__group">
<div class="hs-form__field-row">
<div class="hs-form__field-row__column">
<div class="hs-form__field hs-form__field-firstname hs-firstname"><label id="firstname-label" for="firstname-input" class="hs-form__field__label" data-required="true"><span lang="en">First name</span><span
class="hs-form__field__label__required">*</span></label><input id="firstname-input" class="hs-form__field__input" type="text" name="firstname" required="" autocomplete="given-name" inputmode="text" aria-invalid="false"
aria-required="true" value=""></div>
</div>
<div class="hs-form__field-row__column">
<div class="hs-form__field hs-form__field-lastname hs-lastname"><label id="lastname-label" for="lastname-input" class="hs-form__field__label" data-required="true"><span lang="en">Last name</span><span
class="hs-form__field__label__required">*</span></label><input id="lastname-input" class="hs-form__field__input" type="text" name="lastname" required="" autocomplete="family-name" inputmode="text" aria-invalid="false"
aria-required="true" value=""></div>
</div>
</div>
</div>
</div>
<div class="hs-form__row">
<div class="hs-form__group">
<div class="hs-form__field-row">
<div class="hs-form__field-row__column">
<div class="hs-form__field hs-form__field-email hs-email"><label id="email-label" for="email-input" class="hs-form__field__label" data-required="true"><span lang="en">Email</span><span
class="hs-form__field__label__required">*</span></label><input id="email-input" class="hs-form__field__input" type="email" name="email" required="" autocomplete="email" inputmode="email" aria-invalid="false" aria-required="true"
value=""></div>
</div>
</div>
</div>
</div>
<div class="hs-form__row">
<div class="hs-form__group">
<div class="hs-form__field-row">
<div class="hs-form__field-row__column">
<div class="hs-form__field hs-form__field-mobilephone hs-mobilephone"><label id="mobilephone-label" for="mobilephone-input" class="hs-form__field__label" data-required="true"><span lang="en">Mobile phone number</span><span
class="hs-form__field__label__required">*</span></label>
<div class="hs-form__field__phone"><input id="mobilephone-input" class="hs-form__field__input" type="tel" name="mobilephone" required="" autocomplete="tel" inputmode="tel" aria-invalid="false" aria-required="true" value=""></div>
</div>
</div>
</div>
</div>
</div>
<div class="hs-form__row">
<div class="hs-form__group">
<div class="hs-form__field-row">
<div class="hs-form__field-row__column">
<div class="hs-form__field hs-form__field-how_will_you_be_attending_ hs-how_will_you_be_attending_"><label id="how_will_you_be_attending_-label" for="how_will_you_be_attending_-input" class="hs-form__field__label"
data-required="true"><span lang="en">Are you currently residing in Chicago?</span><span class="hs-form__field__label__required">*</span></label><select id="how_will_you_be_attending_-input" class="hs-form__field__input is-placeholder"
name="how_will_you_be_attending_" required="" aria-invalid="false" aria-required="true">
<option label="Please Select" disabled="" value="">Please Select</option>
<option label="Yes" value="In-Person">Yes</option>
<option label="No I'm a virtual member" value="Virtually">No I'm a virtual member</option>
</select></div>
</div>
</div>
</div>
</div>
<div class="hs-form__row">
<div class="hs-form__group">
<div class="hs-form__field-row">
<div class="hs-form__field-row__column">
<div class="hs-form__field hs-form__field-es_membership__demo_ hs-es_membership__demo_"><label id="es_membership__demo_-label" for="es_membership__demo_-input" class="hs-form__field__label" data-required="true"><span lang="en">1871
Membership</span><span class="hs-form__field__label__required">*</span></label><select id="es_membership__demo_-input" class="hs-form__field__input is-placeholder" name="es_membership__demo_" required="" aria-invalid="false"
aria-required="true">
<option label="Please Select" disabled="" value="">Please Select</option>
<option label="Early Stage Membership" value="Early Stage Membership">Early Stage Membership</option>
<option label="Growth Stage Membership" value="Growth Stage Membership">Growth Stage Membership</option>
<option label="Late Stage Membership" value="Late Stage Membership">Late Stage Membership</option>
<option label="Corporate Membership" value="Corporate Membership">Corporate Membership</option>
<option label="1871 Tenant" value="1871 Tenant">1871 Tenant</option>
<option label="None" value="None">None</option>
</select></div>
</div>
</div>
</div>
</div>
<div class="hs-form__row">
<div class="hs-form__group">
<div class="hs-form__field-row">
<div class="hs-form__field-row__column">
<div class="hs-form__field hs-form__field-community_type hs-community_type">
<div id="community_type-label" class="hs-form__field__label" data-required="false"><span lang="en">Community type</span></div>
<div style="display: flex; flex-grow: 1; align-items: flex-start; justify-content: flex-start; flex-direction: row;">
<div class="hs-form__field__options__container" role="group" aria-invalid="false" aria-labelledby="community_type-label">
<div style="align-self: flex-start; flex: 0 1 auto;"><label id="community_type-label-1" class="hs-form__field__label hs-form__field__checkbox__label"><input id="community_type-input-1"
class="hs-form__field__input hs-form__field__checkbox__input" type="checkbox" name="community_type" aria-invalid="false" aria-labelledby="community_type-label-1" value="Mentorship"><span
class="hs-form__field__checkbox__label-text">Mentor</span></label></div>
<div style="align-self: flex-start; flex: 0 1 auto;"><label id="community_type-label-2" class="hs-form__field__label hs-form__field__checkbox__label"><input id="community_type-input-2"
class="hs-form__field__input hs-form__field__checkbox__input" type="checkbox" name="community_type" aria-invalid="false" aria-labelledby="community_type-label-2" value="Community partner"><span
class="hs-form__field__checkbox__label-text">Partner</span></label></div>
<div style="align-self: flex-start; flex: 0 1 auto;"><label id="community_type-label-3" class="hs-form__field__label hs-form__field__checkbox__label"><input id="community_type-input-3"
class="hs-form__field__input hs-form__field__checkbox__input" type="checkbox" name="community_type" aria-invalid="false" aria-labelledby="community_type-label-3" value="EIR"><span
class="hs-form__field__checkbox__label-text">EIR</span></label></div>
<div style="align-self: flex-start; flex: 0 1 auto;"><label id="community_type-label-4" class="hs-form__field__label hs-form__field__checkbox__label"><input id="community_type-input-4"
class="hs-form__field__input hs-form__field__checkbox__input" type="checkbox" name="community_type" aria-invalid="false" aria-labelledby="community_type-label-4" value="Founder"><span
class="hs-form__field__checkbox__label-text">Founder</span></label></div>
<div style="align-self: flex-start; flex: 0 1 auto;"><label id="community_type-label-5" class="hs-form__field__label hs-form__field__checkbox__label"><input id="community_type-input-5"
class="hs-form__field__input hs-form__field__checkbox__input" type="checkbox" name="community_type" aria-invalid="false" aria-labelledby="community_type-label-5" value="Thought Leader"><span
class="hs-form__field__checkbox__label-text">Thought Leader</span></label></div>
<div style="align-self: flex-start; flex: 0 1 auto;"><label id="community_type-label-6" class="hs-form__field__label hs-form__field__checkbox__label"><input id="community_type-input-6"
class="hs-form__field__input hs-form__field__checkbox__input" type="checkbox" name="community_type" aria-invalid="false" aria-labelledby="community_type-label-6" value="Neighborhood"><span
class="hs-form__field__checkbox__label-text">Neighborhood</span></label></div>
<div style="align-self: flex-start; flex: 0 1 auto;"><label id="community_type-label-7" class="hs-form__field__label hs-form__field__checkbox__label"><input id="community_type-input-7"
class="hs-form__field__input hs-form__field__checkbox__input" type="checkbox" name="community_type" aria-invalid="false" aria-labelledby="community_type-label-7" value="VC"><span class="hs-form__field__checkbox__label-text">VC
</span></label></div>
<div style="align-self: flex-start; flex: 0 1 auto;"><label id="community_type-label-8" class="hs-form__field__label hs-form__field__checkbox__label"><input id="community_type-input-8"
class="hs-form__field__input hs-form__field__checkbox__input" type="checkbox" name="community_type" aria-invalid="false" aria-labelledby="community_type-label-8" value="Tenant"><span
class="hs-form__field__checkbox__label-text">I branded an 1871 office</span></label></div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="hs-form__row">
<div class="hs-form__group">
<div class="hs-form__field-row">
<div class="hs-form__field-row__column">
<div class="hs-form__field hs-form__field-company hs-company"><label id="company-label" for="company-input" class="hs-form__field__label" data-required="true"><span lang="en">Company name</span><span
class="hs-form__field__label__required">*</span></label><input id="company-input" class="hs-form__field__input" type="text" name="company" required="" autocomplete="organization" inputmode="text" aria-invalid="false"
aria-required="true" value=""></div>
</div>
</div>
</div>
</div>
<div class="hs-form__row">
<div class="hs-form__group">
<div class="hs-form__field-row">
<div class="hs-form__field-row__column">
<div class="hs-form__field hs-form__field-industry_type hs-industry_type"><label id="industry_type-label" for="industry_type-input" class="hs-form__field__label" data-required="true"><span lang="en">Company Industry</span><span
class="hs-form__field__label__required">*</span></label><input id="industry_type-input" class="hs-form__field__input" type="text" name="industry_type" required="" inputmode="text" aria-invalid="false" aria-required="true" value="">
</div>
</div>
</div>
</div>
</div>
<div class="hs-form__row">
<div class="hs-form__group">
<div class="hs-form__field-row">
<div class="hs-form__field-row__column">
<div class="hs-form__field hs-form__field-jobtitle hs-jobtitle"><label id="jobtitle-label" for="jobtitle-input" class="hs-form__field__label" data-required="true"><span lang="en">Company role</span><span
class="hs-form__field__label__required">*</span></label><input id="jobtitle-input" class="hs-form__field__input" type="text" name="jobtitle" required="" autocomplete="organization-title" inputmode="text" aria-invalid="false"
aria-required="true" value=""></div>
</div>
</div>
</div>
</div>
<div class="hs-form__row">
<div class="hs-form__group">
<div class="hs-form__field-row">
<div class="hs-form__field-row__column">
<div class="hs-form__field hs-form__field-please_describe_your_company_s_unique_value_proposition_in_2_sentences_or_less_ hs-please_describe_your_company_s_unique_value_proposition_in_2_sentences_or_less_"><label
id="please_describe_your_company_s_unique_value_proposition_in_2_sentences_or_less_-label" for="please_describe_your_company_s_unique_value_proposition_in_2_sentences_or_less_-input" class="hs-form__field__label"
data-required="true"><span lang="en">What makes your company unique?</span><span class="hs-form__field__label__required">*</span></label><input id="please_describe_your_company_s_unique_value_proposition_in_2_sentences_or_less_-input"
class="hs-form__field__input" type="text" name="please_describe_your_company_s_unique_value_proposition_in_2_sentences_or_less_" required="" inputmode="text" aria-invalid="false" aria-required="true" value=""></div>
</div>
</div>
</div>
</div>
<div class="hs-form__row">
<div class="hs-form__group">
<div class="hs-form__field-row">
<div class="hs-form__field-row__column">
<div class="hs-form__field hs-form__field-featured hs-featured"><label id="featured-label" for="featured-input" class="hs-form__field__label" data-required="true"><span lang="en">Why do you want to be featured?</span><span
class="hs-form__field__label__required">*</span></label><input id="featured-input" class="hs-form__field__input" type="text" name="featured" required="" inputmode="text" aria-invalid="false" aria-required="true" value=""></div>
</div>
</div>
</div>
</div>
<div class="hs-form__row">
<div class="hs-form__group">
<div class="hs-form__field-row">
<div class="hs-form__field-row__column">
<div class="hs-form__field hs-form__field-industry hs-industry"><label id="industry-label" for="industry-input" class="hs-form__field__label" data-required="true"><span lang="en">How are you changing the tech industry?</span><span
class="hs-form__field__label__required">*</span></label><input id="industry-input" class="hs-form__field__input" type="text" name="industry" required="" inputmode="text" aria-invalid="false" aria-required="true" value=""></div>
</div>
</div>
</div>
</div>
<div class="hs-form__row">
<div class="hs-form__group">
<div class="hs-form__field-row">
<div class="hs-form__field-row__column">
<div class="hs-form__field hs-form__field-involved_in_1871_programs hs-involved_in_1871_programs">
<div id="involved_in_1871_programs-label" class="hs-form__field__label" data-required="false"><span lang="en">What have you been involved in @1871?</span></div>
<div style="display: flex; flex-grow: 1; align-items: flex-start; justify-content: flex-start; flex-direction: row;">
<div class="hs-form__field__options__container" role="group" aria-invalid="false" aria-labelledby="involved_in_1871_programs-label">
<div style="align-self: flex-start; flex: 0 1 auto;"><label id="involved_in_1871_programs-label-1" class="hs-form__field__label hs-form__field__checkbox__label"><input id="involved_in_1871_programs-input-1"
class="hs-form__field__input hs-form__field__checkbox__input" type="checkbox" name="involved_in_1871_programs" aria-invalid="false" aria-labelledby="involved_in_1871_programs-label-1" value="BLKtech Cohorts"><span
class="hs-form__field__checkbox__label-text">Affinity Programs- BLKtech, LTNtech, WMNtech</span></label></div>
<div style="align-self: flex-start; flex: 0 1 auto;"><label id="involved_in_1871_programs-label-2" class="hs-form__field__label hs-form__field__checkbox__label"><input id="involved_in_1871_programs-input-2"
class="hs-form__field__input hs-form__field__checkbox__input" type="checkbox" name="involved_in_1871_programs" aria-invalid="false" aria-labelledby="involved_in_1871_programs-label-2" value="AI Innovation Labs"><span
class="hs-form__field__checkbox__label-text">Innovation Labs- Supply Chain, FoodTech, Cannabis, AI</span></label></div>
<div style="align-self: flex-start; flex: 0 1 auto;"><label id="involved_in_1871_programs-label-3" class="hs-form__field__label hs-form__field__checkbox__label"><input id="involved_in_1871_programs-input-3"
class="hs-form__field__input hs-form__field__checkbox__input" type="checkbox" name="involved_in_1871_programs" aria-invalid="false" aria-labelledby="involved_in_1871_programs-label-3" value="Events"><span
class="hs-form__field__checkbox__label-text">Events- Scale Up, Juneteenth, International Women's Day</span></label></div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="hs-form__row">
<div class="hs-form__group">
<div data-hsfc-id="RichText" style="font-size: 14px; color: rgb(51, 71, 91);">
<h3>Personal Information</h3>
</div>
</div>
</div>
<div class="hs-form__row">
<div class="hs-form__group">
<div class="hs-form__field-row">
<div class="hs-form__field-row__column">
<div class="hs-form__field hs-form__field-please_provide_your_linkedin_url hs-please_provide_your_linkedin_url"><label id="please_provide_your_linkedin_url-label" for="please_provide_your_linkedin_url-input" class="hs-form__field__label"
data-required="false"><span lang="en">Personal LinkedIn URL</span></label><textarea id="please_provide_your_linkedin_url-input" class="hs-form__field__input" name="please_provide_your_linkedin_url" aria-invalid="false"></textarea>
</div>
</div>
</div>
</div>
</div>
<div class="hs-form__row">
<div class="hs-form__group">
<div class="hs-form__field-row">
<div class="hs-form__field-row__column">
<div class="hs-form__field hs-form__field-instagram_handle hs-instagram_handle"><label id="instagram_handle-label" for="instagram_handle-input" class="hs-form__field__label" data-required="false"><span lang="en">Instaram
URL</span></label><input id="instagram_handle-input" class="hs-form__field__input" type="text" name="instagram_handle" inputmode="text" aria-invalid="false" value=""></div>
</div>
<div class="hs-form__field-row__column">
<div class="hs-form__field hs-form__field-twitterhandle hs-twitterhandle"><label id="twitterhandle-label" for="twitterhandle-input" class="hs-form__field__label" data-required="false"><span lang="en">Twitter URL</span></label><input
id="twitterhandle-input" class="hs-form__field__input" type="text" name="twitterhandle" inputmode="text" aria-invalid="false" value=""></div>
</div>
<div class="hs-form__field-row__column">
<div class="hs-form__field hs-form__field-tiktok_handle hs-tiktok_handle"><label id="tiktok_handle-label" for="tiktok_handle-input" class="hs-form__field__label" data-required="false"><span lang="en">Tiktok URL</span></label><input
id="tiktok_handle-input" class="hs-form__field__input" type="text" name="tiktok_handle" inputmode="text" aria-invalid="false" value=""></div>
</div>
</div>
</div>
</div>
<div class="hs-form__row">
<div class="hs-form__group">
<div class="hs-form__field-row">
<div class="hs-form__field-row__column">
<div class="hs-form__field hs-form__field-headshot hs-headshot"><label id="headshot-label" for="headshot-input" class="hs-form__field__label" data-required="true"><span lang="en">Headshot</span><span
class="hs-form__field__label__required">*</span></label><input type="file" id="headshot-input" class="hs-form__field__input" name="headshot" required="" size="30" aria-invalid="false" aria-required="true"></div>
</div>
</div>
</div>
</div>
<div class="hs-form__row">
<div class="hs-form__group">
<div data-hsfc-id="RichText" style="font-size: 14px; color: rgb(51, 71, 91);">
<h3>Company Information</h3>
</div>
</div>
</div>
<div class="hs-form__row">
<div class="hs-form__group">
<div class="hs-form__field-row">
<div class="hs-form__field-row__column">
<div class="hs-form__field hs-form__field-company_linkedin hs-company_linkedin"><label id="company_linkedin-label" for="company_linkedin-input" class="hs-form__field__label" data-required="true"><span lang="en">Company LinkedIn
URL</span><span class="hs-form__field__label__required">*</span></label><input id="company_linkedin-input" class="hs-form__field__input" type="text" name="company_linkedin" required="" inputmode="text" aria-invalid="false"
aria-required="true" value=""></div>
</div>
</div>
</div>
</div>
<div class="hs-form__row">
<div class="hs-form__group">
<div class="hs-form__field-row">
<div class="hs-form__field-row__column">
<div class="hs-form__field hs-form__field-website hs-website"><label id="website-label" for="website-input" class="hs-form__field__label" data-required="true"><span lang="en">Website URL</span><span
class="hs-form__field__label__required">*</span></label><input id="website-input" class="hs-form__field__input" type="text" name="website" required="" inputmode="url" aria-invalid="false" aria-required="true" value=""></div>
</div>
</div>
</div>
</div>
<div class="hs-form__row">
<div class="hs-form__group">
<div class="hs-form__field-row">
<div class="hs-form__field-row__column">
<div class="hs-form__field hs-form__field-company_instagram_handle hs-company_instagram_handle"><label id="company_instagram_handle-label" for="company_instagram_handle-input" class="hs-form__field__label" data-required="false"><span
lang="en">Company Instagram URL</span></label><input id="company_instagram_handle-input" class="hs-form__field__input" type="text" name="company_instagram_handle" inputmode="text" aria-invalid="false" value=""></div>
</div>
<div class="hs-form__field-row__column">
<div class="hs-form__field hs-form__field-company_twitter hs-company_twitter"><label id="company_twitter-label" for="company_twitter-input" class="hs-form__field__label" data-required="false"><span lang="en">Company Twitter
URL</span></label><input id="company_twitter-input" class="hs-form__field__input" type="text" name="company_twitter" inputmode="text" aria-invalid="false" value=""></div>
</div>
<div class="hs-form__field-row__column">
<div class="hs-form__field hs-form__field-company_tiktok hs-company_tiktok"><label id="company_tiktok-label" for="company_tiktok-input" class="hs-form__field__label" data-required="false"><span lang="en">Company Tiktok
URL</span></label><input id="company_tiktok-input" class="hs-form__field__input" type="text" name="company_tiktok" inputmode="text" aria-invalid="false" value=""></div>
</div>
</div>
</div>
</div>
<div class="hs-form__row">
<div class="hs-form__group">
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<option label="ClimateTech (Energy and Sustainability)" value="ClimateTech (Energy and Sustainability)">ClimateTech (Energy and Sustainability)</option>
<option label="Cybersecurity" value="Cybersecurity">Cybersecurity</option>
<option label="E-Commerce, Brand, RetailTech (including fashion, interior design, etc)" value="E-Commerce, Brand, RetailTech (including fashion, interior design, etc)">E-Commerce, Brand, RetailTech (including fashion, interior design,
etc)</option>
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<option label="EntertainmentTech (Social Media & Consumer Apps & Gaming)" value="EntertainmentTech (Social Media & Consumer Apps & Gaming)">EntertainmentTech (Social Media & Consumer Apps & Gaming)</option>
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<option label="Materials" value="Materials">Materials</option>
<option label="MediaTech (AdTech, PR, Digital Marketing Solutions)" value="MediaTech (AdTech, PR, Digital Marketing Solutions)">MediaTech (AdTech, PR, Digital Marketing Solutions)</option>
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<option label="Social Impact" value="Social Impact">Social Impact</option>
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<option label="SportsTech (Sports)" value="SportsTech (Sports)">SportsTech (Sports)</option>
<option label="SupplyChainTech (Logistics, Supply Chain, Transportation, Industry 4.0)" value="SupplyChainTech (Logistics, Supply Chain, Transportation, Industry 4.0)">SupplyChainTech (Logistics, Supply Chain, Transportation, Industry
4.0)</option>
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