Student-Retiree Application

Membership Type *

Full time student: $125.00

Retired member: Free membership, $20.00 per meeting

First Name *

Middle Name

Last Name *

Company Name

Address

Address 2

City

State

Zip Code

Telephone

Business Email

Business Title

Are you a member of national SHRM?

Yes

SHRM National Member Email

Certifications

Hobbies

Programs that would be of interest to you

Were you referred by someone, if so name of the referring member:

Will you be paying by credit card today on the site or mailing a check?

Credit Card

Check

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Southside Virginia SHRM