Member Application (copy)

* First Name

* Last Name

Accreditations PHR, SPHR, aPHR, aPHIi, PHRi SPHRi, PHRca, GPHR, SHRM-CP, SHRM-SCP,

Position/Title

* Business Name

* Contact Address

Address 2

* City

* State

* Zip

* Phone

* Email

* Are you a current member of the National SHRM organization?

Yes
No

SHRM National Member Email SHRM National Member Email (Not displayed in Membership directory)

SHRM Membership Expiration Date Enter the approximate expiration date of your SHRM membership. Example: March 2019

If a SHRM member, will you designate UCHRA as your primary SHRM chapter? *To be eligble for the SHRM member rate you must designate UCHRA as your home chapter in your SHRM profile

Yes
No

Industry

Primary Areas of Responsibility

How did you hear about UCHRA?

* Volunteer Opportunities UCHRA has many ways to volunteer with the association and our community. Please check here if you would like more information or contact [email protected].

Yes
No, not at this time.

* May we share your profile in our New Member Spotlight on Social Media?

Yes
No

Membership dues

You will be prompted to select and pay for your membership dues after clicking Submit at the bottom of this form.

Regular Full Member: Pay a $175.00 fee to cover membership dues and the costs of all lunches for the full calendar year.

SHRM Member: Pay a $150.00 fee to cover membership dues and the costs of all lunches for the full calendar year.

Student Member: Free and no cost for lunches for the full calendar year. (Must be enrolled as a full-time student at an accredited university or college.)

Please Read Before Submitting:

The information you have provided will be included in our Membership Directory (provided ONLY to members).

Once your account has been activated, you can manage your member record and mark any fields that you do not want included.

You will receive a response to your application shortly.

Please print a copy of this page so you have a copy of your application for your records.

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