Membership Renewal Form

Name*

First Last

Certifications*

Other Certifications

Employment

Organization*

Title*

Organization Address*

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Phone Number*

Fax

E-mail*

Type of Business

Indicate any other professional or technical associations with which you are affiliated:

Membership Category*

If you are currently a SHRM member, please include your SHRM number.

Which, if any, committees are you interested in participating?

Additional Comments

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Total

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