RIVER VALLEY
HUMAN RESOURCE
ASSOCIATION
PO Box 4168 Chapter #606
White River Junction, VT 05001
www.rvhra.org
2017 Membership Application & Questionnaire
New Renewal DATE:______
PHR Certified SPHR Certified GPHR Certified SHRM-CP Certified SHRM-SCP Certified Please use this designation on my listing
Name: / [NOTE: RVHRA membership is individual, not business.]Title:
/ Phone:
Business/Organization Name / Fax:
Business Address: / Email:
City/State/Zip:
Years In Human Resources: / Company Website URL:
Notification of RVHRA meetings and other special events: Please use work email address home email address
From time to time, we would like to contact your supervisor to alert them of upcoming events or just to say thanks for their support. Please indicate their contact information below. Their information will not be released to any external parties.
Supervisor Name / TitleMailing address if different than yours: / Supervisor email address:
Number of Employees in Company: Fewer than 20 21-50 51-100 101-249
250-499 500-999 1,000+
Helpful Membership Information
MEMBERSHIP REFERRALS:
If you know of other Human Resource professionals or businesses that might be interested in RVHRA membership information, please provide their names, titles, and addresses and we’ll be happy to forward information to them.
May we include a note mentioning your name as the person who referred them? Yes Prefer Not
TOPICS, SPEAKER RECOMMENDATIONS & RESOURCES:
We welcome feedback on topics of interest for meetings and/or workshops. In addition, if you know of or have personally heard a dynamic speaker, we’d appreciate learning the name of that person. You can also help fellow HR professionals by sharing the names of resources you’ve found particularly helpful.
TOPICS:
SPEAKERS: Please include contact information and subject area.
WANT TO GET INVOLVED?
RVHRA is always looking for enthusiastic volunteers! Please indicate your willingness to help out in the following areas:
Programs Membership Event Planning Serving in a Leadership Role Surveys Diversity
Workforce Readiness Legislative Human Resources Certification Publicity/Writing Articles for Newspaper or Website
Community Service Other
MEMBERSHIP DUES INFORMATION
Please note that our membership year and dues are January – December of each year.
Enrollment Jan 1, 2017 - December 31, 2017:
Basic individual RVHRA membership - new current non-SHRM members $75.00
Discounted RVHRA membership – new & current SHRM members: $55.00
Student RVHRA membership – available to current students: $10.00
PLEASE NOTE!!
· If you take and pass the SPHR/PHR/SHRM-CP/SHRMP/SCP/GPHR in a given year, RVHRA gives you the next year of membership for free – so be sure to let us know!!
· Are you an HR professional who was a paid member of RVHRA in 2016 and you are in transition – between jobs? The RVHRA board is pleased to offer you a once in a career opportunity to be exempt from paying dues in 2017.
Society for Human Resource Management Member #______SHRM membership through ______
Membership entitles you to program discounts throughout the year! Annual meeting and legislative update meeting may have extra meeting fees.
Enrollment as Business Resource Member: Qualifies for introductory paragraph on Website, with logo, plus link to your URL.
NOTE: SHRM membership must be applied for separately. You may apply and get information at: http://www.shrm.org. When obtaining SHRM membership, please designate RVHRA as your chapter affiliation (#606). Your designation provides SHRM funding to RVHRA based on that affiliation. Check the SHRM web site for special programs for new members! And use the new-member discount offered by SHRM by using Code 0118 when applying for SHRM membership.
Payment Enclosed
Dues for 2017 / $ / Exempt (see above) / Make check payable to: River Valley Human Resource AssociationBusiness Resource / $ / ($25.00 – Optional) / Mail check with application to:
SHRM Foundation
Donation / $ / ($5.00 – Optional) / River Valley Human Resource Association
Attn: Membership Director
TOTAL /
$
/ /P.O. Box 4168
White River Junction, VT 05001