Membership Application------- Printable version

Business name: _______________________________________________

Address:   ___________________________________________________

City/State/Zip: _______________________________________________

Phone: _________________________ Fax: _________________________

Website: _____________________________________________________

Type of business: ______________________________________________ 

Year Founded: ______________# of Full-time (FTE) Employees: ________

Total family members active in business: ____    # of generations: ______

List all family and key non-family members involved in the business:
Name & Position in Company

1)___________________________________________________________

E-mail:__________________________________

2)___________________________________________________________

E-mail:__________________________________

3)___________________________________________________________

E-mail:__________________________________

4)___________________________________________________________

E-mail:__________________________________
(Use the back of this page or a separate sheet to list additional members.)

2008 Membership Rates*
20 or less employees                                            $250
21-75 employees                                                 $500
76 or more employees                                          $700

All-inclusive membership 76 or more employees       $1800

Professional Membership**                                  $500
*Note: Membership rates are based upon total number of company employees (full-time equivalent).  **Non-family owned business professionals, individual membership.

Please make checks payable to PFBA and mail to:

Prairie Family Business Association, USD School of Business
2205 North Career Ave, Sioux Falls, SD 57107
 

For credit card payments, complete below and fax to (866) 624-8161:

Card #____________________________________________
VISA or MasterCard Expiration Date: _________________                     Name on card: _____________________________________
Signature: _________________________________________