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Hampton Roads SHRM SHRM Primary Chapter Designation
Chapter #: 102 Chapter Name: Hampton Roads SHRM
I hereby designate the above named chapter as my primary chapter for SHRM membership coding purposes. I understand that: 1. This in no way precludes membership in other chapters.2. This allows SHRM to list my membership to this chapter for financial support program purposes only.
(You must be a current national member of the Society for Human Resource Management to complete this form.)
Please type or neatly print the following information.
Date: _____________________
Name: _____________________________________________________________________________
SHRM Member ID#: ______________________________
Company Name: _____________________________________________________________________
Address: ___________________________________________________________________________
City: ______________________________________________ State: _______ Zip: _______________
Phone: ________________________ Fax: ________________________
Email: ______________________________________________________________________________
Member’s Signature: ___________________________________________
Thank you!
Please submit this completed form to:
HRSHRM #0102Attn: Brian Winterstein, Vice President of Membership638 Independence Parkway, #240Chesapeake, VA 23320
Fax: 757-842-4839Email: sayres@hrshrm.org
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