P

2009 Membership Form

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PLEASE PRINT IT AND FAX IT TO

952-440-1611

Membership Categories (Please Check One)

Home Based Business     $175
Non-Profit Organization   $250
Under 5 Employees         $250
Under 20 Employees       $300
Under 50 Employees       $350
Under 100 Employees     $400

Over 100 Employees       $500
Associate Member           $175
      (Includes Retired Individuals, Clergy,
         Elected Officials, and Community Members)

Please use the form below to make any changes:
Today’s Date: (mm/dd/yy)

Business Name:

Primary Contact:

Address Line 1:

Address Line 2:

City: State: Zip Code:

Phone: ( ) -

Fax: ( ) -

E-mail: Website:

YES! I would like to add an additional amount of $ , for Chamber technology updating.

Number of Employees:

Type of Business:

Type of Business (Additional Category):

If you would like your business listed in more than one category, please select the extra listing(s) above and add $25 per additional listing.

Names of others in your organization that would like to receive Chamber Information and Newsletter.
Name: Email:

Name: Email:



P.O. Box 114 Prior Lake, Minnesota 55372 Phone: 952-440-1000 sandi@priorlakechamber.com
		2009 Membership Form THIS FORM IS NOT WORKING PROPERLY PLEASE PRINT IT AND FAX IT TO 952-440-1611 Membership Categories (Please Check One) Home Based Business $175 Non-Profit Organization $250 Under 5 Employees $250 Under 20 Employees $300 Under 50 Employees $350 Under 100 Employees $400 Over 100 Employees $500 Associate Member $175 (Includes Retired Individuals, Clergy, Elected Officials, and Community Members) Please use the form below to make any changes: Today’s Date: (mm/dd/yy) Business Name: Primary Contact: Address Line 1: Address Line 2: City: State: Zip Code: Phone: ( ) - Fax: ( ) - E-mail: Website: YES! I would like to add an additional amount of $ , for Chamber technology updating. Number of Employees: Type of Business: Type of Business (Additional Category): Type of Business (Additional Category): If you would like your business listed in more than one category, please select the extra listing(s) above and add $25 per additional listing. Names of others in your organization that would like to receive Chamber Information and Newsletter. Name: Email: Name: Email:

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