The
Human Resource Leadership Forum
Application
Form
DUES: $500 for annual fee, prorated to $250 if applying
between July 1-December 31
| 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
and fax to: |
Name:________________________________________________
Date:________________________________________________
Nickname for Badge:_______________________________________
Title:_________________________________________________
Organization:__________________________________________
Mailing Address:_______________________________________
____________________________________________________
City, State, ZIP:________________________________________
Business phone: (________)_______________________________
Fax number: (________)_________________________________
E-mail address:________________________________________
Number of years 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:_____________________________________
Product or services:___________________________________
Number of employees:________________________________
Company revenue: $___ million $___ billion $___
| 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:_______________________________
__________________________________________________
How did you hear about HRLF?
___renewing; ____was a guest; ___HRMG website; ___received program notice;
___other - specify ____________________________________
Payment:
Check #_____________ enclosed for $_________
Charge $______ to my: ___Mastercard; ___Visa; ___Discover; ___American Express
Card number:_______________________________________________________
Expires: (MM/YY)____/_____
Signature:___________________________________________________________
HRLF is a 501(6) corporation; EIN # 04-300-5931