ACHRA NEW MEMBERSHIP

Renewing Your Membership? - CLICK HERE FOR RENEWAL FORM

Please complete the contact information for the Membership Directory.
Please Note: Be sure to complete all relevant fields and click the SUBMIT button at the end of the form in order for the information to be sent to the Membership Committee for review.
*A red asterisk denotes a required field

First Name:
Last Name:
Prefer To Be Called:
E-Mail:	(E-mail)
Present Employer:
Preferred Mailing Address:
Is Your Preferred Address For:	Home Business
Work Phone:
Fax:
Type of Business:
Job Title:
Home Address:
Home Phone:
Mobile Phone:
Membership Type:	view membership types
Are You a SHRM Member:	Yes No
If "Yes", SHRM Membership Number:
SHRM Membership Type:
Please list any other SHRM Chapter you’re affiliated with:
Do you hold any Certifications?
PHR Certification:	Yes
SPHR Certification:	Yes
GPHR Certification:	Yes
Other Certifications:
Why are you interested in ACHRA Membership?:
Briefly describe your most recent job responsibilities:
How Long Have You Held This Position:
Status:	Exempt Non-Exempt
Positions You Supervise:
Your Supervisor's Name & Title:
Most Recent Assignment:
Company Name:
Company Location (city, state):
Title:
# Years In Exempt HR Position:
Additional Related Work Experience: NOTE: include Company Name, Title and years in an exempt position:
Education – School(s) Attended and Degree(s) Earned:
Area of specialized knowledge or interest (Check all that apply):
Selection and Placement:		Labor Relations:
Compensation/Payroll:		Benefits/Welfare Plans:
Development (organizational/career):		Communications/PR:
Government Regulations:		Safety/OSHA:
Performance Management:		International HR:
Training:		Position Evaluation & Analysis:
Employee Relations:		EEO/Affirmative Action:
Policies and Procedures:		HR Information Systems:
Other:
Committees on which you would be interested in serving (Check all that apply):
Membership:		Programs:
HR Conference:		Professional Development:
Marketing/PR:		Sponsorship:
Community Relations:		Legislative:
Website:		Newsletter:
Workforce Readiness:		None At This Time:
In submitting this form and requesting Membership in the ACHRA organization, I agree in good faith to abide by the ACHRA Code of Ethics, ACHRA Mission and Membership Directory which I have read on the previous page. (PLEASE NOTE: clicking this this link will open the page in a new window or tab - close out that window or tab to return to this form without losing any information)
Digital Signature:
Date:	(Date m/d/yy)
Referred By:
Payment Method:	Mail Check PayPal