SHRM Primary Chapter Designation

Chapter #: 098      Chapter Name: Human Resource Association of Broward County

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 my 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 member of the Society for Human Resource Management to complete this form.)

COMPANY     ___________________________________________________

ADDRESS    ___________________________________________________

                       ___________________________________________________

CITY/STATE/ZIP______________________________________________

PHONE# (Bus/Home) ___________________________________________

DATE _________       MEMBER'S SIGNATURE________________________________
                                                                                     (Member must sign to validate)