
2010 Chapter Membership Enrollment Form
Return Completed Application with Payment to:
SIHRA
Office: 812/378-7300 ext. 236
SIHRA Fax: 812/378-7308
SIHRA is committed to enhancing the strategic impact that member HR professionals contribute to their organizations by becoming the comprehensive resource for all HR professionals in
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Circle the membership appropriate to this application. Separate applications for each member from your organization. For Corporate Membership, please copy the application for each member to complete. Submit all applications together with fees.
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Individual Membership (up to 3 from same co.) If paid by January 15, 2010 |
$65.00 Or $55.00 |
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Corporate Membership (more than 3 from the same co.) If paid by January 15, 2010 |
$200.00 Or $175.00 |
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Indicate Method of Payment: |
CHECK |
CREDIT CARD |
CASH |
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For Credit Card Payment, Please provide: |
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Card Type: |
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Name on Card |
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Card Number |
__________________________________ |
Exp. Date |
__________________________ |
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Signature |
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Name: |
____________________________________________________________ |
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SHRM Member No: |
_______________ |
Certification: |
? PHR ? SPHR ? GPHR |
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Title: |
______________________________________________________________ |
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Employer: |
______________________________________________________________ |
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Employer Website: |
_______________________________________________________ |
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Street Address: |
_________________________________________________________ |
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P.O. Box: |
_________________________________________________________ |
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City: |
___________________________ |
State: |
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Zip Code: |
______________ |
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Business Phone: |
_________________ |
Extension: |
___________________________ |
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Fax: |
_________________ |
E-mail address: |
____________________________ |
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