Chesapeake Human Resources Association Membership Application

***CHRA's Membership year runs from June 1st - May 31st.
If you are joining in a month other than June please see below to calculate your prorated membership amount.
If you have any questions please contact CHRA at 410-752-3318.***


MEMBERSHIP CATEGORY (See member categories in brochure)

Please check member category
__ Professional Active (*SHRM member): $75.00 (includes current / previous HR practitioners or Academicians) -
(prorated amount $6.25 per month)

__ Professional Active (non-SHRM): $90.00
(prorated amount $7.50 per month)

__ Professional Affiliate: $90.00 (includes HR Consultants, Recruiters, Service Providers) Service description:
(prorated amount $7.50 per month)

__ Associate: $90.00 (individual who does not meet the criteria for the Active Category but shall seek a degree in HR or professional certification)
(prorated amount $7.50 per month)

__ Recent Graduate (CHRA student members only - 1st year out of school): $30.00
(prorated amount $2.50 per month)

__ Student (*SHRM member): $5.00

__ Student (non-SHRM): $15.00

*SHRM members must provide Membership ID below.

FOR ALL MEMBERSHIP APPLICANTS:
First Name______________________ Last Name:________________________________ M.I._____________

Job Title: ______________________Nickname:______________________

Professional Certification: __SPHR __PHR __ GPHR __CCP __Other SHRM Membership ID: __________________

Name of Employer: _________________________________________________________________________

Address: ______________________________________________________________________________________

City: ______________________________ State: ___Zip: _______________________________

Telephone: ________________ Fax: ________________ Email Address: _____________________________

Home Address: ______________________________________________________________________________________

City: ______________________________ State: ________________ Zip: ________________________

Home phone: ________________ Home Email Address: _____________________________

Did someone refer you to CHRA? If so please provide that persons name so we can acknowledge them:

MEMBER DEMOGRAPHIC INFORMATION: CHRA uses the following information in planning and developing membership services and programs. Please check the most appropriate box in each category.

Job Function:
o HR Generalist
o Recruitment
o Benefits
o Compensation
o Labor / Industrial Relations
o Training / Development
o Organizational Development
o Legal
o Health, Safety, Security
o Employee Assistance
o Employee Relations
o Communications
o EEO / Affirmative Action
o HRIS
o Research
o Consultant
o Administrative
o International
o Other _______		 Unit Size:
 o Fewer than 100 employees
o 100-249
o 250-499
o 500-999
o 1000-2499
o 2500-4999
o 5000 and over

HR Department Size:
o 1-2 employees
o 3-5 employees
o 6-15 employees
o 16-50 employees
o Over 50 employees
Labor Structure:
o Non-Union
o Union
o Both		 Business/Industry:
o Agriculture, Forestry, Fishing
o Manufacturing (Non-Durable)
o Manufacturing (Durable Goods)
o Transportation
o Utilities
o Wholesale/Retail Trade
o Finance
o Insurance
o Services (Profit)
o Services (Non-Profit)
o Health
o Real Estate
o Educational Services
o Government
o Construction & Mining
o Oil & Gas
o Library
oOther ________

CHRA COMMITTEES

Committee Volunteers are the heart of CHRA. To which of these committees would you be interested in giving your time and energy?

o College Relations
o Community Outreach
o Compensation and Benefits
o Diversity
o Government Affairs		 o Marketing
o Membership Development
o Professional Certification
o Professional Development
o Spring Conference		 o Volunteer Development
o Workforce Readiness

Referral: Please send CHRA membership information to the following:

Name:_________________________________________________________________

Company:_________________ Address:                                                                     

City/State/Zip:                                                                                                           

Payment Options:
o Check payable to CHRA
o Charge to the following credit card: (oVISA, oMasterCard, oAmEx)

Card #: ____________________________________________________ Exp. Date: _____________

Signature of Card Holder _____________________________________________________

I agree to comply with CHRA's Code of Ethics.

Applicant's Signature: _______________________________ Date: ________

Print Name: _____________________________________


720 Light Street, Baltimore, MD 21230
TEL: (410) 752-3318• FAX: (410) 752-8295
EMAIL: CHRA@assnhqtrs.com