First Name: *

Phone *

Street Address

City, State and Zip

Email: *

Company Name

SHRM # *

Southern California Wine Country SHRM Membership Application

I hereby designate the below named chapter as my primary chapter for SHRM membership coding purposes. I understand that: 1. This in no way precludes membership in other chapters. 2. This allows SHRM to list my membership to this chapter for financial support program purposes only. By submitting this form I am requesting local membership and I understand I will receive an email from SHRM confirming. *

0748 - SCWCSHRM

Last Name: *

Date and time

Affiliate Membership Form

Please support your local chapter by becoming a member of Southern California Wine Country SHRM. Your commitment means that our Chapter will continue to receive the support from SHRM that in turn benefits you! Just complete the form below.

Affiliate Membership Form

Chapter

#0748