Member Application

Please fill out the following information in order to become a member.

Account Information

* E-Mail Address

* Gender

Title (Mr/Ms/Dr.)

* First Name

* Last Name

Suffix (Sr, Jr, II, III)

Nick/Screen Name

Your Birthday (12/31/1999)

Your Website

Address

Address Cont.

City/Town

State

Postal Code

Phone

Mobile

Alternate E-Mail

IM Handle

Professional Information

Organization

* Are you self employed?

Your Title

Your Profession

Website (Start With: "http://")

How Many Locations Does Your Company Have?

Only 1 Location in NC
Multiple Locations in NC
Multiple Locations in the US
International

Company Overall Size

What Is The Size Of Your HR Department

Address

Address Cont.

City/Town

Country

State

Postal Code

Phone

SHRM Member

SHRM Membership Number

HR Certified Are you SHRM certified?

HR Certification (Indicate your current HR Certifications)

Additional Information

Chapter CLA Role

* LKNHR Primary Chapter Designation Used to show LKNHR members who designate LKNHR as their home primary chapter.

Local Chapter

More Information

Education/Experience

Social/Volunteer Organizations

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