IPMA-HR Connecticut Chapter

Membership Application

July 1, 2019 – June 30, 2020

NAME:

JOB TITLE:

EMPLOYER:

ADDRESS:

EMAIL:

PHONE: DATE SUBMITTED:

May we contact you to serve on a committee or volunteer? YES NO

FOR INTERNATIONAL IPMA-HR MEMBERS ONLY: Members of International IPMA-HR (both individual members and those covered by an agency membership) pay a discounted rate of $20 for chapter membership dues. In order to determine if you are a member of International IPMA, you must be able to answer YES to all of the following:

• I have a membership number which is• I have log-in access to the International IPMA-HR website http://ipma-hr.org/• I receive emails regularly from International IPMA-HR

If you answered yes to these questions and provided your membership ID number, your dues to join the CT Chapter are $20. If you are still unsure, before writing your check, email Raisa Capellan, Treasurer for the CT Chapter, at raisa.capellan@ct.gov

Check No. Members of International IPMA = $20

CT Chapter IPMA Membership Dues = $40 Check No.

Please make check payable to IPMA-HR CT Chapter and send with completed application to:

IPMA-HR Connecticut Chapter P.O. Box 290973

Wethersfield, CT 06129-0565

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