FVSHRM | Membership

About You

Membership Application for *
First Name *
Middle Initial
Last Name *
E-mail Address *
Gender *

Title
Job Level
Direct Report
Supervisor Name

Direct Phone Number
Direct Fax Number

Are you currently a member of SHRM National?
National SHRM Member #

Do human resource responsibilities currently occupy more than fifty percent (50%) of your time?
Does your employer sell a product or service that has human resource practitioners as customers?
Do you call on human resource practitioners in a selling capacity as a regular part of your job?

Please give a brief description of your position


Primary duties


Prior professional experience (if current position less than 2 years)
Employer
Title
Dates Employed

Company Name *

Main Address *

City *

State *

Zip *

My office has a different address from the main company address

Company Main Phone

Company Phone 2

Company Main Fax

Industry *

Unionized

Contractor

Number of Employees

Please enter the characters in box

By submitting your application, you are agreeing to abide by the Chapter By-Laws.