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Membership Application



    In making this application for membership in the Northwest Connecticut Human Resource Association, I offer the following information in support of my qualifications for membership for January – December 2019.

    DATE:  _________________________, 2019



    Home Address:

    Employed By:


    Company Address:

    Business Phone:


    Nature of Business (attach a brief description from your website):


    Position/Job Title:


    SHRM Membership (circle one):

    YES                       NO

    If yes, SHRM ID Number

    Do you belong to another SHRM Chapter?  If yes, name:


    Do you hold a SHRM Certification: Yes or No

    If yes, which one:   ____SHRM-CP


                                  _________Date Received


    Do you hold a HRCI Certification: Yes or No

    If yes, which one:   ____PHR


                                  _________Date Received


    Would you be interested in volunteering as a leader or on a committee? 

    YES                        NO

    If yes, indicate area:

    President, Treasurer, Membership, Programs, Certification, Communications, Public Relations, Membership Committee, Communications Committee, Programs Committee.


    I would like to Donation to SHRM Foundation:   $_______  Donation can be added to your annual dues payment.


    The objectives of this organization shall be to advance the human resources profession and development of the human resources professional by:

    1. Promoting through the cooperation of its members, the free exchange of information and experience within the limits of state and federal legislation.
    2. Planning and presenting programs and seminars that are relevant to the human resources and employee relation’s discipline.
    3. Stimulating its members to seek professional and personal development.


    This application must be accompanied by payment due by January 31, 2019 $75.00 which includes all of the meetings, food, beverages.  Guests would be $20.00 per meeting.  Checks should be made payable to NWCTHRA, and send to:  NWCTHRA, c/o Treasurer, PO Box 644, Torrington, CT 06790.



    APPROVED BY:  _______________________  ________________

                                                MEMBERSHIP COMMITTEE REP.                     DATE