Membership Application - Join the SHRM Emerald Coast Chapter

Welcome to the SHRM Emerald Coast Chapter

Membership Application
SHRM/Emerald Coast Chapter #459
Attn: Tina Eakes
P.O. Box 5579
Fort Walton Beach, FL 32549-5579

Please follow the procedures below when completing the membership application. If you have any questions, please contact Tina Eakes at 314-8175 or by email at Tina.Eakes@cox.net

Input full first name
Input last name
Input current employer name
Input current title that you hold
Input business address
Input city, state & zip code
Input business phone number
Input business fax number
Input correct email address
Input the number of years in profession
Brief summary of your current job duties
Agree or Disagree
Input date of application
Type of memberships:
     Regular: Professional in the field of Human Resources
     Associate: Bona fide interest in Human Resources
     Corporate: Maximum of 5 HR professionals within a company or
     organization
     Student: College student
Membership year runs from April 1st to March 31st, pro-rated on a quarterly basis.
SHRM National Members, please apply a 10% discount of local membership
Input any HR Certification that you currently hold
Input yes or no as to volunteering on SHRM committees
Click submit

Note: After a new application is submitted online, it will be forwarded to the Director at Large, Memberships. Once the director has the application, it will then be submitted to the board at the next board meeting. The board members meet the 1st Thursday of every month. Once the board has approved membership, the director will generate a welcome email to the new member and an invoice will be attached with your membership type and dues highlighted in red. Please follow the instructions on the invoice for payment.

SHRM-ECC meetings are held the 3rd Wednesday of each month at the Two Trees Restaurant, Fort Walton Beach Golf Course at 7:30 a.m., unless otherwise noted. Please visit the website to make a meeting reservation for each meeting that you will be attending.

+First Name	+Last Name

+Company Name	+Title

+Business Address	+City	+State & Zip

+Phone	+Fax

+Email Address	+Number of Years in Professional Work
		(Exempt Duties, Teaching, or Consulting in field)

+Describe your present job duties

I hereby certify that the information provided above is true and accurate.
+Agree	Yes	No	+Date

Please check type of membership sought: (Membership year runs from April 1^st to March 31^st) Pro-rated Quarterly
			Annual	Jul-Mar	Oct-Mar	Jan-Mar
	Regular	Professional in the field of Human Resources	$50.00	$37.50	$25.00	$12.50
	Associate	Bona fide interest in Human Resources	$45.00	$33.75	$22.50	$11.25
	Student	College Student	$20.00	$15.00	$10.00	$5.00
	*School*
	*Field*

+ Are you a member of National Society for Human Resources Management? There is a 10% discount for national members.
	Yes	No	Membership#

+ Do you hold any professional certifications?
	Yes	No	Type

+ Are you interested in volunteering for any of the committees?
	Yes	No

	Copyright � 2003-2007 The Society for Human Resource Management Emerald Coast Chapter #459 P.O. Box 5579 Fort Walton Beach, Florida 32549-5579 Email: info@shrm-emeraldcoast.org
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