Prior Lake Chamber of Commerce

2008 Membership Form

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:

Submit Application



P.O. Box 114 4775 Dakota Street Prior Lake, Minnesota 55372 Scott County Phone: 952-440-1000 sandi@priorlakechamber.com
		2008 Membership Form 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: Submit Application

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