*Required Field

Salutation          Mr. Miss. Mrs. Dr. None

Title                              

Present Employer           

Area/Function of HR Field:       Choose One HR Generalist Employment/Recruitment Benefits Compensation Labor/Industrial Relations Training/Development Health/Safety/Security EEO/Affirmative Action Research Education Other (please specify)

*Address             

*City                   

*State                 

*Zip                   

*Phone               

 Fax                  

*E-Mail               

Are you a National SHRM Member?                  Yes No

If yes, what is your SHRM membership number?

When did you join SHRM?                            

Please check the certifications you attained:

PHR           CCP
SPHR         CBP
GHPR
 

Other Certification

Amount              

Any specific comments/requests?

SHRM - Montgomery Chapter

Tamela Selmar
P. O. Box 231056
Montgomery, AL  36123-1056
Phone: 334-394-4411
or

Print & FAX to:

334-394-4444

or

Email: tamela.selmar@buffalorock.com

Please allow 5 days for mail.