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City of Lakeville
Lakeville School District 194




U.S. Chamber of Commerce


Lakeville MN Map
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Membership
Application
Submit your application by Fax:
Fax the completed form, including payment information, to:
952-469-2028
Firm Name:
Contact Person:
Title:
Other Representatives:



Category of Business:
Street Address:
Suite/Room/Apt.: (if any)
City:   State:   ZIP:
Phone:     Fax:
E-mail:     Website:
Year Business Founded:     Number of Employees:
Membership Category:
Business Description:
Annual Membership Investment:
One-Time Processing Fee:
Total Investment
+ Processing Fee:

Type of Credit Card:
Visa     MasterCard
Credit Card Number:
Expiration Date:
Name on Credit Card :
Signature:
ZIP Code credit card statements are sent to:
By providing this information, I certify that I understand the appropriate amount will be charged to my credit card based on my selection/s and the information I provide.
This Application is intended to be submitted via Fax.
It cannot be submitted through this Website.

Lakeville Area Chamber of Commerce and
Convention & Visitors Bureau

19950 Dodd Boulevard
Suite 101
Lakeville, MN 55044
Phone: (952) 469-2020 or (888) 525-3845
Fax: (952) 469-2028
E-mail: info@lakevillechambercvb.org

Copyright 1998 - 2011.
Lakeville Area Chamber of Commerce.
All rights reserved.

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