Personal Information

Salutation (required) Select Mr. Ms. Mrs.

First Name (required)

Middle Name

Last Name (required)

Certification Select PHR SPHR GPHR Other

Other Certification

Title

Referred by

Who is paying for the membership (Required) Select Company Paying Membership Personally Paying Membership

Membership Dues (Required) Select HR/NY Only HR/NY & SHRM

Contact Information

Company Name

Company Address 1

Company Address 2

Company Address 3

Company City

Company State Select A State Alabama Alaska Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Company Zip

Phone

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Company Fax

E-Mail (required)

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The above information will be posted to Member Section of our website for active members. Signing in will allow you the ability to update your contact information, to view another member's contact info, and to learn about member-only events. Checking the check box above will not allow other members to have access to this information.

Home Address 1 (Required)

Home Address 2

Home Address 3

Home City (Required)

Home State (Required) Select A State Alabama Alaska Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Home Zip (Required)

Home Phone (Required)

Note: If you are already on our mailing list please be sure to use the same last name and email address used in the emails you currently receive from us so we can update your existing record correctly.

SHRM #
If you are currently a member of National SHRM, you must enter your SHRM Member number. We cannot process your HR/NY application without it.

Years in HR (Required) Select Less than 3 3-5 6-9 10-15 15+

Mailing Preference (Required) Select Home Office

Check here if you do NOT want to be listed in the online directory. Please note we do not publish home information in the directory or share it with members. However, your email address will be listed in the directory.

National Membership Categories

Please list other professional associations to which you belong

Our member list is available to rent to HR related organizations. Check here if you would like your name removed from this rental list.

I would describe my role as (Required) Select HR Practitioner Consultant/Attorney/Service Provider Educator

Demographic Information
The following information is for demographic analysis only, which helps us provide better service to our members. This information is kept strictly confidential.

Business & Industry Code (Required) Select Agriculture, Forestry, Fishing Manufacturing (non-durable goods) Manufacturing (durable goods) Transportation Utilities Wholesale/Retail Trade Finance Insurance Services (Profit) Services (Non-Profit) Health Real Estate Educational Service Government Construction & Mining Oil & Gas Library-Corp./Public/Academic Publishing Independent Consultant

Company Size (Required) Select Less than 100 100 - 499 500 - 999 1,000 - 2,499 2,500 - 4,999 5,000 - 9,999 10,000 - 24,999 25,000 +

Department Size (Required) Select Less than 5 5 - 9 10 - 24 25 - 49 50 - 99 100 and over

Education Select High School Some College Bachelor's Degree Some College beyond Bachelor's Master Degree MBA Doctorate

Function (Required) Select HR Generalist Employment/Recruitment Benefits Compensation Labor/Industrial Relations Training/Development Organizational Development Legal Health, Safety, Security Employee Assistance Programs Employee Relations Communications EEO/Affirmative Action HRIS Research Consultant Administrative International HRM Diversity

Race/Ethnic Identification Select Multi-cultural American Indian-Alaskan Native Asian-Pacific Islander Black Hispanic White Other

Title (Required) Select President Vice President Assistant Vice President Director Assistant Director Manager Supervisor Specialist Administrator Representative Legal Counsel Academician Librarian Consultant

Unit Level in Organization (Required) Select Plant Region Division Group Subsidiary Corporate Other