The
Human Resource Leadership Forum
2007 Membership Application Form
DUES: $600 for
annual fee, prorated to $350 if applying for half-year
membership from June 1-December 31.
2006 members newly in transition: $150 Jan-June: $150 July-Dec.
New 2007 members in transition: $300 Jan-June; $300 July-Dec.
Dues cover all HRLF offerings, there are no additional charges. Members
may send a substitute when unable to attend a program, and may bring
one guest per calendar year at no additional charge.
Members who recruit a new member for 2007 will be reimbursed $100 after the new member has joined.
Name of new member: __________________________________________________
| If paying by check, send appropriate
amount with form to: Pat Lee Association Manager HRLF 354 Washington Street, Suite 223 Wellesley Hills, MA 02481 |
If paying your dues by credit card, indicate appropriate amount
print and fax to: |
Name:_____________________________________ Nickname for badge: _________________________
Title:________________________________ Organization:______________________________________
Mailing Address:_______________________________________________________________________________
City, State, ZIP:________________________________________________________________________
Business phone: (___)_____________ Fax:(____)_____________ E-mail:_________________________
Professional data:
Number of years in HR:____ Are you in transition?: yes__ no__ What was your first year in HR? _____
Check the category that best describes your current position:
| Within an organization: | __ highest tier in HR |
| __ second tier in HR | |
| __ professional level |
Number of years at executive level:____ Type of industry:_____________________________________
Types of Products or Services:____________________________________________________________
Company revenue: $___; $___ million; $___ billion
Number of employees:___________________
| As a consultant: | __ sole proprietor of a firm |
| __ principal of a larger firm | |
| __ consultant within a firm |
Number of years in consulting:_____ Types of services offered:_______________________________
Would you like to join the Outreach Committee which provides pro bono professional HR services to
organizations in the community? Yes___ No___
Would you like to join the Membership/Marketing Committee which stays in tune with what the present and future membership wants and needs? Yes___ No___
Are you a member of HRPS? Yes___ No___
How did you hear about HRLF?
___renewing; ____was a guest; ___HRLF website; ___received emailed program notice;
___received mailing; ___other - specify ____________________________________________________
Payment:
Check #_____________ enclosed for $_________
Charge $______ to my: ___Mastercard; ___Visa; ___Discover; ___American Express
Card number:___________________________________ Expires: (MM/YY)____/_____
Name on card:__________________________________________________________________________
Street number and zip code for card _______________________________________________________
HRLF is a 501(6) corporation; EIN # 04-300-5931