New Member Application

PAGE 1

Institutional Information

Institution Name: *

Institution City: *

Institution State: *

Institution Home Page:

HR Office Home Page:

Institution Type: *

System Office/Board of Regents institutions are automatically assigned Dues Code 4. Please make sure that Dues Code 4 is selected on the following page.

Due to our current membership promotion , you will receive a 10% discount on your dues.

You selected "Other." Please specify:

Support:

Your Contact Information

Your Name: *

Your Phone: *

Your E-mail: *

If membership in CUPA-HR was recommended by another member, please note his/her name and institution:

PAGE 2

Dues Schedule for Institutional Membership

CUPA-HR has institutional-based memberships. The number of members allowed in an institution's membership is determined by the institution's total budget (not the HR department's budget).

If you know your IPEDs Unit ID, click here to lookup your Dues Code.

If you know your institution's total budget, but do not know your IPEDs Unit ID, click here to look up your Dues Code. Your budget information will be verified by CUPA-HR before your membership is activated.

If you do not know your Unit ID or your institution's total budget, please contact CUPA-HR Member Service toll-free at 877-CUPA-HR4 (877-287-2474) or via memberservice@cupahr.org.

System Office/Board of Regents institutions are automatically assigned Dues Code 4 and the corresponding 8 representatives. You are welcome to add additional representatives on the following page for $30 each.

Please select 4 in the Dues Code drop-down box below.

Dues Code: *

Dues:$

Your dues amount listed here reflects a 10% discount given during our current membership promotion.

You will be able to add additional representaties on the following page. Additional representatives are $30 each.

Representatives

Key Representative

List the person most responsible for directing the human resource function. This person will be the key contact for CUPA-HR.

Name *

Title: *

Street Address *

Address continued

City *

State *

Zip *

Telephone: *

Fax:

E-mail: *

Representative #2

Name:

Title:

Street Address

Address continued

City

State

Zip

Telephone:

Fax:

E-mail:

Representative #3

Name:

Title:

Street Address

Address continued

City

State

Zip

Telephone:

Fax:

E-mail:

Representative #4

Name:

Title:

Street Address

Address continued

City

State

Zip

Telephone:

Fax:

E-mail:

Representative #5

Name:

Title:

Street Address

Address continued

City

State

Zip

Telephone:

Fax:

E-mail:

Representative #6

Name:

Title:

Street Address

Address continued

City

State

Zip

Telephone:

Fax:

E-mail:

Representative #7

Name:

Title:

Street Address

Address continued

City

State

Zip

Telephone:

Fax:

E-mail:

Representative #8

Name:

Title:

Street Address

Address continued

City

State

Zip

Telephone:

Fax:

E-mail:

Representative #9

Name:

Title:

Street Address

Address continued

City

State

Zip

Telephone:

Fax:

E-mail:

Representative #10

Name:

Title:

Street Address

Address continued

City

State

Zip

Telephone:

Fax:

E-mail:

Representative #11

Name:

Title:

Street Address

Address continued

City

State

Zip

Telephone:

Fax:

E-mail:

Representative #12

Name:

Title:

Street Address

Address continued

City

State

Zip

Telephone:

Fax:

E-mail:

Representative #13

Name:

Title:

Street Address

Address continued

City

State

Zip

Telephone:

Fax:

E-mail:

Representative #14

Name:

Title:

Street Address

Address continued

City

State

Zip

Telephone:

Fax:

E-mail:

Representative #15

Name:

Title:

Street Address

Address continued

City

State

Zip

Telephone:

Fax:

E-mail:

Representative #16

Name:

Title:

Street Address

Address continued

City

State

Zip

Telephone:

Fax:

E-mail:

Representative #17

Name:

Title:

Street Address

Address continued

City

State

Zip

Telephone:

Fax:

E-mail:

Representative #18

Name:

Title:

Street Address

Address continued

City

State

Zip

Telephone:

Fax:

E-mail:

Representative #19

Name:

Title:

Street Address

Address continued

City

State

Zip

Telephone:

Fax:

E-mail:

Representative #20

Name:

Title:

Street Address

Address continued

City

State

Zip

Telephone:

Fax:

E-mail:

PAGE 3

Additional Representatives

If you would like to add more representatives to your institution's membership roster (above the number of representatives allowed by the dues schedule), it is only an additional $30 per person.

If you need to add more than 20 additional representatives, contact a Member Service representative for assistance toll free at 877-CUPA-HR4 (877-287-2474) or via e-mail at memberservice@cupahr.org.

Please indicate the number of additional representatives (if any) you would like to purchase

Additional Representative #1

Name:

Title:

Street Address

Address continued

City

State

Zip

Telephone:

Fax:

E-mail:

Additional Representative #2

Name:

Title:

Street Address

Address continued

City

State

Zip

Telephone:

Fax:

E-mail:

Additional Representative #3

Name:

Title:

Street Address

Address continued

City

State

Zip

Telephone:

Fax:

E-mail:

Additional Representative #4

Name:

Title:

Street Address

Address continued

City

State

Zip

Telephone:

Fax:

E-mail:

Additional Representative #5

Name:

Title:

Street Address

Address continued

City

State

Zip

Telephone:

Fax:

E-mail:

Additional Representative #6

Name:

Title:

Street Address

Address continued

City

State

Zip

Telephone:

Fax:

E-mail:

Additional Representative #7

Name:

Title:

Street Address

Address continued

City

State

Zip

Telephone:

Fax:

E-mail:

Additional Representative #8

Name:

Title:

Street Address

Address continued

City

State

Zip

Telephone:

Fax:

E-mail:

Additional Representative #9

Name:

Title:

Street Address

Address continued

City

State

Zip

Telephone:

Fax:

E-mail:

Additional Representative #10

Name:

Title:

Street Address

Address continued

City

State

Zip

Telephone:

Fax:

E-mail:

Additional Representative #11

Name:

Title:

Street Address

Address continued

City

State

Zip

Telephone:

Fax:

E-mail:

Additional Representative #12

Name:

Title:

Street Address

Address continued

City

State

Zip

Telephone:

Fax:

E-mail:

Additional Representative #13

Name:

Title:

Street Address

Address continued

City

State

Zip

Telephone:

Fax:

E-mail:

Additional Representative #14

Name:

Title:

Street Address

Address continued

City

State

Zip

Telephone:

Fax:

E-mail:

Additional Representative #15

Name:

Title:

Street Address

Address continued

City

State

Zip

Telephone:

Fax:

E-mail:

Additional Representative #16

Name:

Title:

Street Address

Address continued

City

State

Zip

Telephone:

Fax:

E-mail:

Additional Representative #17

Name:

Title:

Street Address

Address continued

City

State

Zip

Telephone:

Fax:

E-mail:

Additional Representative #18

Name:

Title:

Street Address

Address continued

City

State

Zip

Telephone:

Fax:

E-mail:

Additional Representative #19

Name:

Title:

Street Address

Address continued

City

State

Zip

Telephone:

Fax:

E-mail:

Additional Representative #20

Name:

Title:

Street Address

Address continued

City

State

Zip

Telephone:

Fax:

E-mail:

PAGE 4

Salary Survey

As a CUPA-HR member, you receive your choice of one (1) complimentary salary survey. Please select one of the following: Administrative Compensation Survey
Mid-Level Salary Survey
National Faculty Survey
Community College Salary Survey

Person Who Will Be Completing Your Institution's Surveys

Name:

E-mail:

Does your institution have more than one survey contact? Yes

You will be contacted by someone from the CUPA-HR research department to get the information for your survey contacts.

Total Dues

Total Dues$

Payment Options

Please select your payment option: *

Payment by Check

Please mail a check to:

CUPA-HR
Attn: Membership
Department 888204
Knoxville, TN 37995-8204

Membership will be activated upon receipt of dues payment.

Payment by Credit Card

If you would like to pay by credit card, you will receive an e-mail with payment information within one business day.

Membership will be activated upon receipt of dues payment.

Comments

If you have any questions, comments or special instructions, please describe them here.

Submit

When you hit Submit, your application will be sent to a CUPA-HR Member Service representative. Your application will be reviewed and processed and an e-mail allowing you to view and print your invoice or pay by credit card online will be sent to you within one business day.