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Member Application

Step 1: Member Info

Step 2: Additional Info

Step 3: Primary Contact

Step 4: Billing Contact

Step 5: Membership Options

Step 1:

Member Info

Company Name *

Please add your company name.

Leave Blank

Phone *

Please add your company phone number.

Website *

Please add your company website.

Email *

Please add a valid email.

Physical Address

Address line 1 *

Please add your address.

Address line 2

Country *

Please add your country.

City *

Please add your City.

State *

Please add your State.

State *

Please add your State.

State *

Please add your State.

Postal Code *

Please add your Postal Code.

Mailing Address

Same as physical address

Address line 1

Address line 2

Country

City

State

State *

Please add your State.

State

Postal Code

Step 2:

Additional Info

Business Description (100 char max)

Business Keywords (enter a space between words)

Directory Category

Full-time Employees *

Please add your number of full-time employees.

Part-time Employees *

Please add your number of part-time employees.

Step 3:

Primary Contact

First Name *

Please add your first name.

Last Name *

Please add your last name.

Title *

Please add your title.

Phone *

Please add your phone number.

Cell Phone

Fax

Email *

Please add a valid email.

Contact Preference

Email

Phone

Create Account

This Login is already in use

Login *

Please add your login username.

Password *

Please add your login password.

Step 4:

Billing Contact

Same as Primary Contact

First Name *

Please add your first name.

Last Name *

Please add your last name.

Title *

Please add your title.

Phone *

Please add your phone number.

Cell Phone

Fax

Email *

Please add a valid email.

Contact Preference

Email

Phone

Create Account

This Login is already in use

Login *

Please add your login username.

Password *

Please add your login password.

Step 5:

Membership Package

Please select a Membership Package

Level 1 $ 500

1-10 Full Time Employees

Level 2 $ 750

11-25 Full Time Employees

Level 3 $ 1,000

26-50 Full Time Employees

Level 4 Please contact us to determine the fee.

50+ Full Time Employees

Additional Fees:

Processing Fee $30 one time

(One-time Fee)

Comments/Questions

Payment Option

Bill Me

Charge my credit or debit card

Please complete the Captcha

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		@MplsChamber \| @BloomMNChamber \| @NeMplsChamber 81 South 9th Street, Suite 200, Minneapolis, MN 55402 \| 612.370.9100

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