Member Application
First Name:
Last Name:
HR Certification:
Title:
Company:
Industry:
Address:
City:
State:
Zip:
Office Phone:	Ext:
Fax:
E-mail:
Home Address:
Home City:
Home State:
Home Zip:
Home Phone:
Organization website address:
How were you referred to Tri-State? If referred by a Tri-State member, please write the member's name in the box.
If you are a SHRM member would you like to designate Tri-State as your chapter of choice? Yes No SHRM ID#

2008 Membership - $50.00 General Membership Fee.
If using credit card, please choose personal or business. Company (from above) Personal (from above)
Please choose the address as billing address. Home (from above) Company (from above)

Special Instructions:
Comments: Pressing "Confirm" will redirect the applicant to a secured site to complete the application form.