Young Professionals of the Coulee Region Application

Please complete the following form to apply for membership in the Young Professionals of the Coulee Region (YPCR) group, part of the La Crosse Area Chamber of Commerce. For questions, please reach out to yp@lacrossechamber.com or call 608-784-4880.

First Name *

Last Name *

Job Title

Employer

Address Line 1 *

Address Line 2

City *

Zip/Postal Code *

Email Address *

Phone Number *

Best phone number to reach you at.

Cell

(optional, for text reminders)

Date of Birth *

Format: M/d/yyyy

Required to confirm the age restriction of 21-40 year old individuals.

Applying as a

La Crosse Area Chamber Member ($50/year) La Crescent Chamber Member ($70/year) Non-Member ($110/year)

Please tell us why you want to join the Young Professionals of the Coulee Region *

Payment Method *

Please specify how you wish to be billed.

Please select which one applies:

I have lived here all my life. I grew up here and moved back. I relocated here and found a job. I was hired and then relocated here.

Please specify who is funding this membership

Employer Personally

Young Professionals of the Coulee Region Application

Join Our Mailing List

You have Successfully Subscribed!