St. Lucie HR Association - Member Application

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Member Application

* First Name

Middle Initial

* Last Name

Birth Date (MM/DD)

Certifications

PHR
SPHR
SHRM-CP
SHRM-SCP

* SHRM Member?

If SHRM Member, Please enter Member #

* Title

* Company Name

* Address Company

Address Line 2 Company

* City Company

State Company

* Zip/ Postal Code Company

* Primary Phone Number

* Primary Email Address

Alternative Email Address

* Would you like to receive non-association mail?

Yes
No

Referred By?

* Please Select Chapter Designation

Primary Chapter Designation: I hereby apply for membership and designate the St. Lucie County Human Resources Association as my Primary Chapter. I understand this in no way precludes membership in other chapters.
Non-Primary Chapter Designation: I hereby apply for membership, but designate another as my Primary Chapter. I understand this in no way precludes membership in other chapters.