Prospera Business Network · Membership Form

Contact Information

Organization Name

*

Business Owner Name

*

First Name

Last Name

Job Title

*

Email

*

Verify Email

*

Phone

*

Address to be Displayed on Directory (Business Address)

*

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Alternate Contact

First Name

Last Name

Alternate Contact Email Address

Verify Email

Membership Info

*Solopreneur level is available to sole business owner with no employees.

Amount

*

$10,000 - Economic Partner

$5,000 - Community Leader

$2,500 - Executive

$1,200 - Partner

$600 - Contributor

$300 - Associate

$150 - Solopreneur (No Employees)

Donation Schedule

Continue donating until

(mm/dd/yyyy)

Website

Website hyperlinks are included in members' directory listing at Contributor ($600) Level and above.

Number of Employees

Company Description

Please provide a brief description of your company/business

Are you/colleagues interested in joining a committee/board? If so, enter name/email below:

Anything else we should know? Questions/comments?

Referral source

We like saying thanks! If you were referred by someone please let us know by whom!

Do you want to receive emails from us?

*

Newsletters, Member Events, Training Opportunities

Yes, please!