Golden Triangle Human Resource Association - GTHRA
Local Membership Application*
(Applicable only to the period of February 2001-February 2002)

Please complete and return with payment (if applicable) to the address listed below.  ALL members should complete and return regardless of local or national membership.

Please provide the following contact information:

Name
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
FAX
E-mail

What is your current membership classification (refer to by-laws)?:

Would you like to be considered for a volunteer leadership position in a committee?:

Yes
No

Total years in personnel work?

If you are a member of SHRM, What is your membership number?

I hereby apply for membership in the Golden Triangle Human Resource Association and agree to pay the annual dues.** I pledge to abide by the bylaws, practice and uphold the code of ethics, and support the Association in meeting its goals and objectives.

Annual dues can be paid in one of four ways.  The fee listed is nonrefundable. The options are:  Choose one of the following options:

1.  $125 - Local Membership.  Covers annual dues and lunches up to and including January 2002.
2.  $100 - National Membership. For SHRM Members. Covers lunches up to and including Jan. 2002.
3.  $25 - Local Membership. Covers annual dues.  Lunches will be paid by member at each meeting.
4.  $0 - National Membership.  For SHRM Members.  Lunches will be paid by member at each meeting.

Return to: Matthew Stollak
                 Box 9581
                 Dept. of Management and Information Systems
                 Mississippi State, MS 39762
*Affiliated with the Society for Human Resource Management (SHRM).  Membership in GTHRA does not entitle one to hold office in SHRM or vote in national affairs.

**Make checks payable to GTHRA.  SHRM Members do not pay local dues but still need to complete the application.

Copyright © 2001 GTHRA. All rights reserved.
Revised: January 13, 2003