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Join Us

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Please fill in the following
form…

Name: 
     

Title: 

Organization:         

Street:  
  City: 
    State:

Hospital    
Nursing Home     
HMO   Other:   

Work Phone:  
  Social
Security # :   

CURRENT EMPLOYER:    Years of Service: 
      Hospital  #Beds:  

Responsibilities:    

Are you replacing someone? 
Yes 
No
        Who? 

Are you a member a ASHHRA? 
Yes
 
No     

Since?

AVAILABLE MEMBERSHIPS – PLEASE CHECK ONE

FULL
MEMBERSHIP
: Full membership in ISHHRA shall be available to an individual who is
employed by a healthcare provider in the State of Indiana and who is actively involved in
the Human Resources function of that organization.

ASSOCIATE
MEMBERSHIP
: Associate membership in ISHHRA is available to those who have
demonstrated interest or involvement with healthcare Human Resources administration and
who do not otherwise qualify for full membership.  Associate members enjoy the rights
an privileges afforded full members with the expection of the right to vote, to be an
officer or a director, and they may not use the Society’s name for materials or
presentations.

Annual Full Membership fee is $30.00 per member;  $25.00
each additional member(s) within the same organization.  Annual Associate Membership
is $250.00 per member.  Please make checks payable to ISHHRA and mail with completed
applications(s) to: