MSHHRA - Maine Society for Healthcare Human Resources Administration

Application for Membership

Please complete the following form to be considered for membership.

* = required

Contact Information

body:

* First Name:

* Last Name:

* Title:

* Organization:

* Organization Type:

* # of Employees:

* Address:

Address(2):

* Town:

* State:

* Zipcode:

* Phone:

Fax:

* email:

Web site:

(format: "www.website.com")

Professional Certifications and Affiliations

* Education:

Are you certified as a(n):

PHR SPHR CEBS FACHE CHE

Are you a member of ASHHRA?

Yes No

Are you a member of any other Maine HR Associations?

Yes No

Are you a member of "SHRM"? (All vendors must be members of SHRM prior to applying for MSHHRA membership)

Yes No

SHRM Member #:

If you are a member of any boards, please list them:

Membership Category

Please select a category

Regular - $75 Actively engaged in a human resource function in a hospital, physician practice, long-term care facility, home care agency or other health care facility or organization in Maine.
Associate - $25 Human resource professional currently not employed by a health care facility or organization.
Student - $25 Student actively pursuing a degree in a human resource related field
Vendor - $100 Representative from an organization that is a service provider to our members (All vendors must be SHRM members)
Honorary Individual who, although not eligible for any other membership classification, has made significant contributions to the goals of MSHHRA and has been voted as an honorary member by MSHHRA.
Life Individual who is: an active member in good standing who becomes disassociated from the health care field after 10 or more consecutive years of membership; (or) is a member who retires because of age or disability after having completed between five and ten years of such membership. (Life membership must be granted by MSHHRA membership

Competencies

Please select up to five competencies in which you feel you have the most expertise to offer other members.

Access

If your application for membership is approved, you'll use this username/password to access the Members-only section of our Web site.

* Username:

* Password:

I have reviewed and accept the Terms and Conditions