Prospera Business Network · Membership Form

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Membership Form

Contact Information

Organization Name

Primary Contact Name

First Name

Last Name

Job Title

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

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!”

Add 3% to my total amount to help cover the payment processing fees