New Membership Form Enter your National SHRM # and Create a Password. Please be sure to note your password as you will need to enter your National SHRM # and your newly created password to receive member-level prices when registering for Dulles SHRM chapter meetings. National SHRM # * Create Password * First Name * Last Name * Are You a Student Member? YES Professional Accreditation (Check Relevant)  SPHR PHR GPHR CEBS APS APD AP AEP CCP CBP RODP RODC Other Directory Information Please indicate information for the Chapter directory. If it is not business information please indicate "None" in the Title and Company fields. Title Business/Company Name Address City  State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code Business Telephone Business E-mail Mailing Information Address * Address (cont.) City *  State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming * Zip Code * Telephone * E-mail * Membership Payment Type Payment Type Pay Now with Credit Card Pay at Meeting Free Student * Chapter Information Primary Chapter Designation: Dulles Other * Indicate Primary Designation If Not Dulles NOTE: SHRM National recognizes only one chapter as your official or primary chapter. The Dulles SHRM Chapter will be designated as your primary chapter unless you select "Other" above and indicate your primary chapter designation. Demographics Please indicate your response to each of the following by checking the appropriate choice. This information assists us in analyzing the demographics of our chapter membership and helps us to plan dinner programs and activities. Gender Decline To Answer Male Female Department Size Decline To Answer Less than 5 5-9 10-24 25-49 50-99 100+ Years in HR Decline To Answer Under 1 1-5 6-10 10+ Retired Age Decline To Answer 18-30 31-49 50+ Race Decline To Answer Multicultural American Indian/Alaskan Native Asian/Pacific Islander Black/African American Hispanic Caucasian Other Education Decline To Answer High School Some College Bachelor's Degree Master's Degree MBA Doctorate Other Business/Industry Decline To Answer Consulting Education Finance/Insurance/Real Estate Government Health Care High-Tech Manufacturing Newspaper/Publishing/Broadcasting Retail/Wholesale Services (Profit) Services (Non-Profit) Transportation Utilities Other Company Size Please Choose Less than 100 100-499 500-1999 2000-4999 5000-9999 10000+ HR Functional Specialty: (Check all that apply) HR Generalist Employment/Recruitment Benefits Compensation Training/Development HRIS International HR Employee/Labor Relations Organizational Development Legal Health/Safety/Security Diversity Consultant     Indicate Other Specialty: I understand that in order to join the Dulles Chapter, I must satisfy the following requirements: Be a dues paying member in good standing with National SHRM. Be considered and approved for membership by the Board of Directors of the Dulles Chapter. Pay annual dues of $30.00 each January to the Dulles Chapter (in addition to National dues). Signed ( Please re-type name ) * *Membership in the Dulles Chapter will be accepted upon receipt of your National SHRM membership number. The Dulles Chapter is a 100% Chapter, i.e., all members are required to join National SHRM prior to joining the Dulles Chapter. Membership in the national organization must be maintained to continue Dulles SHRM membership. NOTE: For new members who join during the 4th calendar quarter (October-December), paid dues cover the remainder of the current calendar year as well as the following calendar year. If mailing $30.00 membership dues, mail payment to: Treasurer Dulles SHRM P.O. Box 1249 Herndon, VA 20172-1249 Membership Payment Related Questions: Edwina Orndoff or Tim Kelly, CLU, Treasurer Other Membership Related Questions: Michelle Milam, Vice President, Membership