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First Name Last Name Business/Organization Name Title Address 1 City State Select Below Military AA Military AE Alaska Alabama Military AP Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Guam Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Virgin Islands Vermont Washington Wisconsin West Virginia Wyoming Zip Code Contact Phone Fax Email Address Website Charter Membership: If I am taking advantage of the reduced rates for the Charter Membership to Join the Chamber of Commerce or to Renew My Membership which has been inactive for at least one (1) year, I agree to the required 2-year commitment. Yes No I would like to pay my membership fees (please select appropriate payment option): Annually (Payment in Full) Semi-Annually (Payments due by 1/31 and 7/31) Quarterly (Payments Due 1/31, 4/30, 7/31, and 10/31) Monthly (Payments due by the 15th of each month) Membership Catagory (please choose the ONE that best fits your membership category ~ see the Membership Tiers & Rates webpage for additional descriptions) Tier 1: Individuals & Families Tier 2: Chamber of Commerce Tier 2: Churches Tier 2: City/County/State Government Offices & Services Tier 2: Educational Facilities Tier 2: Non-Profit Organizations Tier 3: Home/Part-time Businesses Tier 4: Agriculture/Dairy Productions Tier 4: Auto, Farm, & Marine Parts and/or Repair Tier 4: Home & Housing Contractors & Service Tier 4: Lodging (Level 1) Tier 4: Specialty Retail & Services Tier 5: Dining Tier 5: Industrial & Manufacturing Tier 5: Para-Professionals Tier 5: Retirement Living & Nursing Homes Tier 5: Wholesale Distributors Tier 6: Advertising, Marketing, & Media Tier 6: Financial Institutions (Level 1) Tier 6: Lodging (Level 2) Tier 6: Professional Services Tier 6: Recreational & Entertainment Tier 6: Retail Tier 6: Utility Companies (Excluding Electric Companies) Tier 7: Large Retail Tier 7: Lodging (Level 3) Tier 8: Financial Institutions (Level 2) Tier 8: Healthcare Systems Tier 8: Electric Companies Tier 9: Casino's & Entertainment Complexes w/ multiple locations Tier 9: Financial Institutions (Level 3) Tier 9: National & International Businesses Description of Product, Services, and/or Business Hours of Operation Do you have any suggestions regarding how the Chamber of Commerce may involve more residents & businesses? I am interested in learning more about (choose as many as apply): Take-a-Kid Fishing Membership Drive - Welcome Committee Waterama Craft Fairs Chamber Cup Golf Tournaments Annual Meeting Grow Minnesota! Visits Sports & Travel Shows Staffing the Chamber Office & Visitor Center Chamber Website Advertising Opportunities Chamber Social Events Chamber Board of Directors Pope County Business Expo Other (Please specify below) Nothing at this time! Are there any activities or events that you or someone you know would be willing to volunteer or work? Yes No Maybe Additional information you wish to share:

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