Membership Application

Name*

First NameLast Name
Certification Type
Other Certification Type
Employment Status
Other Employment Type
Title*
Company Name*
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Years of Experience
Organization Type
Size of Local Organization
Please check all items that apply to your current position

Employee RelationsDiversity/EEORecruitmentHRISCompensationHealth & SafetyOrganizational DevelopmentTraining & DevelopmentBenefitsGeneralist
Membership Info
National Member #
National Membership Expiration Date
If you selected the student membership, please provide your major area of study, university & anticipated graduation date below.
Please make checks payable to Mid South SHRM and send c/o MidSouth SHRM, Franklin, Kentucky 42134. You may pay by credit card by using the QR code below.
Membership Payment
Please scan the QR Code to the right to make your membership payment.

National Member: $15
Local Only Member: $30
Student: FREE
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Membership Info