PALMETTO SOCIETY OF HUMAN RESOURCE MANAGEMENT
Charleston, SC
MEMBERSHIP APPLICATION 2018
Applicant Information
Name ______Phone#: ______
Title: ______Fax#: ______
Company Name: ______E-mail: ______
Mailing Address: ______Certifications: _ SHRM-CP _ SHRM –SCP
_ PHR _ SPHR _ GPHR_Other
National SHRM Member Number: ______
______Current Member _ Former Member
How were you referred to our Chapter? ______
Voluntary Statistical Data
GENDER: ____male ____female
AGE RANGE: ____ under 21 ____ 21-29 _____30-39 ____40-49 ____50-59 ____60 or older
RACE/ETHNIC GROUP:
___ Hispanic or Latino ___ White (Not Hispanic or Latino) ___ Black or African American ___ Asian
___ Native Hawaiian or Other Pacific Islander ___ American Indian or Alaska Native ___ Two or More Races
Membership Categories
PSHRM membership is granted on an individual basis. Memberships are non-transferable to other individuals. Please select one of the following:
____ A. Professional Member
Membership shall be limited to (a) practitioners of human resource management for at least three years; (b) certified by the Human Resource Certification Institute; (c) faculty members holding an assistant, associate or full professor rank in human resource management or any of its specialized functions at an accredited college or university and have at least three years of experience at this level of teaching or less years of experience if they serve as an advisor to a student human resource club or chapter; (d) full-time consultants with at least three years’ experience practicing in the field of human resource management; and/or (e) full-time attorneys with at least three years’ experience in counseling and advising clients on matters relating to the human resource profession. Professional members may vote and hold office in the chapter.
____ C. Student Member
Membership shall be limited to those individuals who are (a) enrolled either as full-time or part-time students, at freshman standing or higher; (b) enrolled in the equivalent of at least six (6) credit hours; (c) enrolled in a four-year or graduate institution and/or a consortium of these or a two-year community college with a matriculation agreement between it and a four-year college or university which provides for automatic acceptance of the community college students into the four-year college or university; (d) able to provide verification of a demonstrated emphasis in human resource management subjects, and (e) able to provide verification of the college or university’s human resources or related degree program. Student members may not vote or hold office in the Chapter.
____ D. Affiliate members:
Membership shall be limited to those individuals whose companies provide products and/or services directly to the professional human resource community and who hold a current SHRM membership. No more than ten percent (10%) of the Association’s membership may fall into this category; because of this limit, no more than one person from any one organization may be an affiliate member. Affiliate members may not vote or hold office in the Association.
Position/Company Information — Please complete the following:
A. Position Function
___ HR Generalist ___ Legal ___ Research
___ Employment/Recruitment ___ Health/Safety/Security ___ Consultant
___ Benefits ___ Employee Assistance ___ Administrative
___ Compensation ___ Employee Relations ___ Other - Specify
___ Labor/Industrial Relations ___ Communications
___ Training/Development ___ EEO/Affirmative Action
___ Organizational Development ___ HRIS
B. Company Size
___ Less than 25 ___ 100 -199 ___ 700 - 999
___ 25 - 49 ___ 200 – 399 ___ 1,000 +
___ 49 – 99 ___ 400 - 699 ___ Consultant
___ N/A
C. Business/Industry Type
___ Agriculture, Forestry, Fishing ___ Services ___ Media
___ Manufacturing ___ Health/Health Care ___ Oil/Gas
___ Transportation ___ Real Estate ___ Library
___ Utilities ___ Educational Services ___ Other - Specify
___ Wholesale/Retail Trade ___ Government ______
___ Banking/Finance ___ Construction ______
I hereby apply for membership in the Palmetto Society of Human Resource Management and agree to pay the applicable membership dues. In applying for membership, I understand that my membership will not start until I am notified by the Association. I also agree to practice and uphold the ethics of the Association, abide by the By-laws and assist in carrying out the objectives of the Association.
Membership Year: January 1 - December 31
Annual Dues (select one):
___ $65.00 for Professional member if not a National SHRM member
___ $55.00 for Professional member if a National SHRM member
(MUST include SHRM # on page 1)
___ $95.00 for Affiliate Members (MUST be a SHRM (National) member – include SHRM # on page 1)
___ Free for Student Members
NOTE: As the number of Affiliate Members is limited, Affiliate members must email their membership applications to: Katy Ditchfield at and mail their checks to the address below or make payment at the next PSHRM meeting. Affiliate membership is on a first-come, first-served basis until spaces are filled.
______
Signature of Applicant Date
Please make checks payable to Palmetto Society of Human Resource Management
(Taxpayer Identification Number 41-2244823)
Forward payment with application to: Palmetto Society Human Resource Management
P.O. Box 62722
North Charleston, SC 29419
For Membership Questions: Contact Katy Ditchfield, VP of Membership at PSHRM will invoice Members for bank fees associated with returned checks due to insufficient funds in the bank account of a Member or the issuance of a Stop Payment by a Member.
PSHRM Use Only
Board Approval: Payment Information: Application Receipt Info:
______Cash Amount ______Date ______
______Check Number ______Time______