Membership Application - 2019
Western KY Society for Human Resource Management
Membership Application
January 1 – December 31, 2019
Name:_________________________________________________________________
Home Address: ________________________________________________________ _
City/State/Zip: __________________________________________________
Cell Phone: _____________________________
Home E-mail: __________________________________________
Employer Name: _________________________________________________________
Job Title: _______________________________________________________________
Work Address: __________________________________________________________
City/State/Zip: ____________________________________________________________
Work Phone: ___________________________________ Ext. __
Work Fax: ______________________ Work E-mail: ________________________________
Where would you prefer mail to be sent? ⬜ Work ⬜ Home
Where would you prefer email to be sent? ⬜ Work ⬜ Home
Are you a current member of the National Society for Human Resource Management (SHRM)?
⬜ No ⬜ Yes: Member Number: ________________ Expiration Date: ___________
Are you certified by the Human Resources Certification Institute (HRCI)?
⬜ No ⬜ Yes If, yes, which designation? ⬜ PHR ⬜ SPHR ⬜ GPHR
Enclose a check for one of the following: (choose only one)
⬜ $50.00 Local/Associate Chapter Membership – WKYSHRM Chapter Member only
OR
⬜ $25.00 Local Chapter Membership – Reduced for National SHRM Member
(Please be sure to complete membership information above.)
OR
⬜ $0.00 Retired Membership or Student Membership
OR
⬜ $150.00 Local/Associate/Organization/Vendor Chapter Membership – WKYSHRM Chapter Member only (This membership allows for up to 3 members of the organization to attend each monthly meeting)
Please take time to list any topics you would like to hear about as well as list any good speakers that you or your company would recommend.
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I hereby apply for membership in the Western KY Society for Human Resource Management and agree to adhere to its Bylaws
Members will maintain the highest standards of professional and personal conduct.
- Members will strive for personal growth in the field of human resource management.
- Members will maintain confidentiality of privileged information.
- Members will refrain from using their official positions, either regular or volunteer, to secure special privilege, gain or benefit for himself/herself.
Signed: _______________________________________ Date: ______________________
If you have any questions concerning membership, please contact Lauren Wilson at 270-498-6941 or Danielle Grace at 270-719-0568.
Please mail completed application and fee (if applicable) to:
Western KY-SHRM
P.O. Box 326
Hopkinsville, KY 42241
