IndySHRM
Membership Application
Name
Certification (PHR, SPHR, GPHR)
Position
Company
Address
City
State
Zip
Phone
Fax
Work/School
E-Mail
Do you or
your company pay for your membership?
Name
of IndySHRM member who recruited you(if
n/a leave blank) :
(Home address, phone and e-mail will
not be published.)
Home
Address
City
State
Zip
Phone
Permanent/Home E-Mail
Are
you a member of SHRM?
Yes
No
If
yes, what is your SHRM membership number?
Demographic Information
What is your gender? What is your ethnicity? What is your geographic location(s) of preference for meetings? Job Function Secondary Job Function Business Industry Company size: Membership type: Number of experience in HR - whole years only
Membership
Type
(with an IndySHRM golf
shirt) -
$195(with an IndySHRM
golf shirt) - $97.50
click
here for more information on SMA-Central Indiana
click
here for more information on the Consutlatns Forum
If
you chose a shirt option, please indicate your
shirt size*please note that purchasing a shirt is a an
additional $35
L
M
S (women's only)
Type
of shirt
Payment
Method
(Make check payable to: IndySHRM, 8945 South Street, Fishers, IN
46038)
Credit
Card #
Expiration
Date
Name
on Card
Amount
Any
specific s?
Print
this form then Please wait until you get
a confirmation screen .
