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1. Full Name (Required.)

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2. Email Address (Required.)

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3. Phone Number:

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4. Chapter Affiliation (Required.)

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5. Are you a SHRM Member (Required.)

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6. Volunteer Role Desired? (Required.)

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7. Company Name (if applicable)

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8. City? (Required.)

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9. Certification(s)?

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10. Chapter Volunteer Experience: (Required.)

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11. Council Experience?

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12. Other:

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