SHRM Learning System Kit - $560

NOTE: Participation in this class does not automatically register you for the HRCI-
administered certification exam. To register for the exam, you must contact
HRCI (www.hrci.org) or at (703) 548-3440.

Be sure that if you are taking the 10 week course, that you register through the Knowledge Center for the class.

Name:

Employer/Agency:

Agency Code:

Employer/Agency Mailing Address:

Phone Number:

(xxx-xxx-xxxx)

Fax:

(xxx-xxx-xxxx)

E-mail:

Preferred Method of Contact:

Email Phone Fax

Please select one:

Manager Supervisor Other

Please select one:

   State Gov't        Local Gov't      Other

Approving Manager/Supervisor:

Job Title:

Optional:

Certified Check or Money Order (made payable to "DHRM")

Agency Payment - The course and participant name must be inserted in the description field. The voucher number must be completed. A copy of the IAT must be faxed to Linda Sledge at (804) 786-9127 prior to the last registration date. See the following coding information.

Inter-Agency Transfer Codes

If your agency is paying for a class with an IAT, the following codes should be used:

Trans Code: 136
Agency #: 129
Fund: 0202
Program/Sub: 704-09
Revenue Source: 03007
Project #: 73100
Cost Code: 731

You may mail the order form to:
DHRM SHRM Registration
101 N. 14th Street, 12th Floor
Richmond, VA 23219
Fax (804) 786-9127

Individual or organization checks must be received by DHRM no later than 2 weeks prior to the start date of the class. Participant and Class information must be provided with all payments.

• If you plan to pay by check, and payment cannot be made two weeks prior to class, you must bring a certified check or money order with you on the first day of class. You must contact PDS to advise us that you will be bringing payment with you and to confirm that there is still space in the class.