New Member Registration

Thank you for your interest in the Pittsburgh Human Resources Association. Below is an application for membership with an e-commerce portion attached so that you can sign up to be a member today! Please note that we reserve the right to change your membership type pending confirmation of status. Please refer to Pittsburgh Human Resources Association’s privacy policy regarding your contact profile information.

Membership

*Membership Type ProfessionalAffiliateStudent    *Membership Term 12 Month Membership

*Username   *Password      *Retype Password

Are you a SHRM Member?

SHRM Member? NoYes

SHRM Member #

SHRM Membership Expiration Date JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember01020304050607080910111213141516171819202122232425262728293031200420052006200720082009201020112012201320142015

Are you a student?

University Name

Membership
*First Name	Middle Name	*Last Name
Certifications
Address
City	State ALABAMA ALASKA ARIZONA ARKANSAS CALIFORNIA COLORADO CONNECTICUT DELAWARE DISTRICT OF COLUMBIA 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	Zip Code
Date Of Birth JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember0102030405060708091011121314151617181920212223242526272829303119011902190319041905190619071908190919101911191219131914191519161917191819191920192119221923192419251926192719281929193019311932193319341935193619371938193919401941194219431944194519461947194819491950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010	Age	Gender FemaleMale
Education Level High SchoolSome CollegeBachelor's DegreeSome College Beyond Bachelor'sMaster's DegreeDoctorateJuris Doctorate
Race American Indian/Alaskan NativeAsian/Pacific-IslanderBlack (Non-Hispanic)HispanicWhite (Non-Hispanic)

Employment
Company	Company Size Fewer than 100100 - 499500 - 9991000 - 24992500 - 49995000 and over	Sector Agriculture, Forestry, FishingConstruction & MiningEducational ServicesFinanceGovernmentHealthHigh-TechIndependent ConsultantInsuranceLegalLibraryManufacturing (Durable)Manufacturing (Non-Durable)Newspaper, Publishing, BroadcastingOil & GasOtherReal EstateService (Profit)Services (Non-Profit)TransportationUtilitiesWholesale/Retail Trade
Address
City	State ALABAMA ALASKA ARIZONA ARKANSAS CALIFORNIA COLORADO CONNECTICUT DELAWARE DISTRICT OF COLUMBIA 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	Zip Code
Job Title	Position AcademicianAdministratorAssistant DirectorAssistant Vice PresidentConsultantDirectorLegal CounselLibrarianManagerOtherPresidentRepresentativeSpecialistSupervisorVice President	Job Function AdministrativeBenefitsCommunicationsCompensationConsultantEEO/Affirmative ActionEmployee AssistanceEmployee RelationsEmployment/RecruitmentHealth,Safety,SecurityHR GeneralistHRISInternationalLabor/Industrial RelationsLegalOrganizational DevelopmentOtherProgramsResearchTraining/Development
Department Size Fewer than 1010 - 2425 - 4950 - 99100 and over	Unit Level CorporateDivisionGroupOtherPlantRegionSubsidiary

Communication
Home Phone	Work Phone	Preferred Communication EmailMailBothOtherNeither
*Email Address	Secondary Email Address	Mail Preference BusinessHome
Cell Phone	Fax