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Membership Form
Contact Information
Organization Name
*
Primary Contact Name
*
First Name
Last Name
Job Title
*
Email
*
Phone
*
Address
*
Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Billing Contact Name (if different from Primary Contact)
First Name
Last Name
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
Industry category
Select one category that represents your business or services.
Accounting / Bookkeeping
Architects / Engineers
Attorneys / Legal / Related
Automotive / Related
Beauty
Child Care Services / Related
Construction / Related
Contracted Business Services
Education
Finance / Banking
Food / Beverage Services
Health / Wellness
Home / Personal Services
Insurance
Internet / Telecommunications
Lodging / Hospitality
Manufacturing
Marketing / Media
Nonprofit / Local Government
Pet Services
Photography
Printing
Real Estate / Related
Recreation / Entertainment
Retail / Wholesale
Software / IT
Staffing / Employment
Utilities
Weddings / Events
Website
Website hyperlinks are included in members' directory listing at Contributor ($600) Level and above.
Number of Full-Time Employees
Number of Part-Time Employees
Are you/colleagues interested in joining a committee/board? If so, enter name/email below:
Logo
Please supply your businesses/organization’s high res logo (PNG or JPG) for use in publicity benefits.
Do you have a member-2-member deal to offer other Prospera members?
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.
Add 3% to my total amount to help cover the payment processing fees