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2008 MEMBERSHIP APPLICATION/UPDATE
Member’s Name: _________________________________________________________
Business Name: __________________________________________________________
Business Address: _________________________________________________________
Business
Phone Number: _____________________ Fax Number: ___________________
Home Phone Number: ________________________
Email Address: ____________________________________________________________
Type of Business: _________________________ Products/Services: ________________
Number of Employees Locally: _______________ Nationally: ________________
Your Position: ___________________________________________________________
Primary responsibilities: ____________________________________________________
SHRM Membership number: _________________________________________________
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Program interests: Please check important topics of interest to you and your company.
Education ______ Personnel Laws ______ Safety ______
Employee assessment ______ Time Management ______ Placement ______
Employee benefits ______ Quality Control ______ Stress/Health ______
Employee Training ______ Recruiting ______ Worker’s Comp. ______
Mgmt Philosophies ______ Retirement Benefits ______ Others: ______
Retention ______ Diversity ______ _________________________
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__________________________________________________ __________________________________
Member Signature Date
Please forward invoice & application form with check to: Wiregrass HRM Association
PO Box 10361
Dothan, AL 36304