Prospera Business Network · Membership Form

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Membership Form

Contact Information

Organization Name

Business Owner Name

First Name

Last Name

Job Title

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 proprietor and consultants, 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!

No, thank you.