Membership Application

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Membership Application

Personal Information

First Name:

Last Name:

Job Title:

Position Type:

HR Practitioner
– Currently working as a HR Manager, Director, VP etc. within a company.
Service Provider
- Currently working as a Consultant or provider of services in support of the HR function to a company or organization.*

Member Type:

Password:

*
(Minimum of 8 characters long)

Confirm Password:

*
(Case Sensitive)

Preferred District:

Professional Designation:

Mailing List:

PIHRA sometimes sells our mailing list to HR product & service companies. If you do not wish to receive these mailings please check this box.

Include in Directory Search:

If "Include in Directory Search" is checked, then the following four Preferred Directory fields are required.

Preferred Directory Address:

Preferred Directory Phone:

Preferred Directory Fax:

Preferred Directory Email:

Home Address Information

Address 1:

Address 2:

City:

State:

Zip:

Phone:

(xxx)xxx-xxxx

How Did you Hear About PIHRA?

I was Referred to PIHRA by:

Business Address Information

Company:

Address1:

Address2:

Address3:

City:

State:

Zip:

Phone:

Ext.
(xxx)xxx-xxxx

Date Employed From:

mm/yyyy

Date Employed To:

mm/yyyy

Are you a SHRM Member?

YesNo

SHRM Member Number:

Preferred Correspondence:

Where would you like your PIHRA mail to be sent? *

HR Functions Performed:

Please check at least one. * AdministrativeGeneralist
Affirmative Action/EEOHRIS/HRMS
BenefitsInternational HR
Career ManagementLabor Relations
CompensationOrganizational Development
CommunicationPolicies and Procedures
ComplianceProfessor
ConsultantResearch
DiversityRelocation
Employee Assistance ProgramsSafety/Health/Security
Employee RelationsStudent
Employment/RecruitmentTraining and Development
Employment LawWorker's CompensationOther:

Previous Human Resources Experience

Company:

Job Title:

Employed From:

mm/yyyy

Exempt:

Company:

Job Title:

Employed From:

mm/yyyy

Exempt:

Company:

Job Title:

Employed From:

mm/yyyy

Exempt:

Demographic Information (Optional)

Gender:

Education:

Company Revenue:

(in millions)

Years In HR:

Company Size:

Race/Ethnic Identification:

Business & Industry Code:

Fax/Email Permission Form

To comply with FCC "Unsolicited" Fax Rules and in response to the deletion of the "established business relationship" clause from the Telephone Consumer Protection Act (TCPA) we are asking our current and potential members to sign this Fax and Email Permission Form. By signing, you are acknowledging that Professionals in Human Resources Association (PIHRA) can send you facsimiles and Email including Membership Renewals, Invoices, Registration and Program Information. Please contact the Membership department at 800-734-5410 or membership@pihra.org with any questions.

If authorization box is checked, these fields are required.

Fax #1 (Primary):

Fax #2:

Email #1 (Primary):

Email #2:

Authorization:

By Checking this box, you are authorizing fax and email permission from Professionals In Human Resources Association (PIHRA).

Date:

7/4/2009

Please acknowledge consent by signing below

Name:

Company:

Signature:

(Typing your name is your electronic signature.)

PIHRA Marketing Information Request

PIHRA offers a number of great opportunities to form a relationship with our members. Website, print, e-blast advertising as well as exhibiting opportunities at PIHRA events, and much more!

Please send me information about PIHRA advertising and sponsorship opportunities.