Please check one of the following categories.

National SHRM Member: Yes    No

Member Number:

Name:

Company Name

Company Address:

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Phone:    Fax:

Home Address:

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Home Phone:

Education: High School Some College Associate Degree Bachelor's Degree Some College beyond Bachelor's Master Degree MBA Doctorate

Certification: (i.e. SPHR, CMC, PHR, etc.):

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Type of Organization: Communications Construction Consulting Education Financial Health Care Manufacturing Government Retail/Wholesale Transportation Utilities Other

Other:

Size of the Organization:  Number of full-time   Number of Part-time

Years of experience in current Position:

Years of Experience in Human Resources:

SHRM Interests

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Membership

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