2011 Membership Application
If you are already a member and your information has
not changed since last year, please check here. □
Please print your name below. You will not need to complete the remainder
of this form. Thank you!
Name: ______
__________
Company/Organization: _____ _____
Position: _____
Address: _____
Phone: _____ Fax: _____
Email: _____
Are you a national SHRM
Member?
Yes / No If yes, member number ___________
Do you currently hold a certification?
PHR /
SPHR
Membership dues:
$15.00 per calendar
year for national SHRM members
$25.00 per calendar
year for non-SHRM members
Make checks payable to: Mississippi Valley Human Resource Association
and return to:
Laura Bailey, Treasurer
Great River Health Systems
1221 S. Gear Ave.
West Burlington, IA 52655