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SHRM Primary Chapter Designation

Chapter Number:
Chapter Name:

I hereby designate the above named chapter as my primary chapter for SHRM membership coding purposes. I understand that:

  1. This in no way precludes membership in other chapters.
  2. This allows SHRM to list my membership to this chapter for financial support program purposes only.
Name:
Member ID:
(You must be a current national member of the Society for Human Resource Management to complete this form.)

**Please fill in the address to which you would like your mailings sent**
Company:
Job Title:
Address:
City:
State:
ZIP:
Business Phone:
Home Phone:
Fax:
E-mail:
Date:
Member must check this box to validate.