DelMarVa Membership Application

Name

Certification

Title

National SHRM Member? Yes or No

SHRM National Number

Organization/Company

Address

City

State

ZIP

Phone

Cell

Fax

E-Mail

DUES

SHRM National Member $30.00

National ID Number

DelMarVa Chapter dues for local membership (National Membership required)

Non-National Member $40.00

DelMarVa Chapter dues for local members who are not members of National

Student Member $15.00

DelMarVa Chapter only (Full time student)

Number of years experience in the field of Human Resources

List your primary responsibilities in the field of HR? Do you have a history of employment in the HR profession?

Are you a professional consultant in the field of Human Resources? Please explain specialty area.

Please list program topics you would find interesting

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Membership