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Your Name


Company Name


Company Industry


Your Position/Title


Business Address


Address (cont.)


Are you willing to accept text message announcements?
Yes
No

City


State


Zip


Email


Work Phone


Cell Phone


How did you hear about us?


Comments/Suggestions


Are you currently in the military or were you in the military?
Yes
No

Birth Date (month/day/year):

Email Program you use:
Outlook
Gmail
Lotus Notes
Other

What is your preferred communication avenue?
Email
Social Media
Website
Text

Event suggestions:


Cost is $35 per year ($10 for college students)

What is your preferred payment method?
Cash
Check
Credit Card
Invoice Employer (*NOTE: Business memberships are available for companies with multiple employees who wish to join.)

If you are paying by credit card please submit this form and call the Willmar Lakes Area Chamber of Commerce with your card information; 320.235.0300

Disclosure
I hereby agree to my membership in the Willmar Area "Next" organization and have notified my employer of my Interest and their financial obligation for my participation. If my employer chooses not to cover the costs for my involvement, I agree to personally pay any expenses due. Membership is continuous and billed annually until written termination is provided.
Agree to disclosure


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