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Renew Your HIA-LI Membership

  

Renew your HIA-LI Membership

Note - Fields marked with a * are required.
Company Name*
Address 1*
Address 2
City*
State*
Zip*
Phone*
Fax
Website
Referred By

We hereby apply for membership in the HIA-LI:*
(Includes a subscription to the Hauppauge Reporter)

$400 Regular Membership
$200 Not-For-Profit Membership
$475 (companies 200+ employees)
$100 Talent Transition Membership*
$100 Get In The Game Membership**

I am including a donation to the HIA-LI Scholarship Fund:
($25 suggested donation)

Company contact person for HIA-LI use and for Membership Directory listing
First Name*
Last Name*
Title*
Email*
Brief description of company*
President's Name*
Human Resource Director
Manufacturing Manager
Number of employees:

Do you ship goods to other countries? Yes No
Do you bring goods in from other countries? Yes No

Please send the Hauppauge Reporter to (Other than contact person. Name & Title)
Name:
Title:
Name:
Title:

METHOD OF PAYMENT*
Membership & Scholarship Fund Donation

Total Amount: ($ Membership / Scholarship)

Visa Master Card American Express Paying by check
Card Holder's Name
Credit Card Number
Expiration Date mm/yy

NOTE: If sending payment by check, please complete, print this form and mail to the address below.

* You must be currently unemployed and actively job seeking to qualify for this membership. Consultants must join as a company membership.
** If you are a member of the millennial generation (18-28) and seeking employment
  


 

  
     

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Learn more about HIA-LI membership and its benefits to your company

HIA-LI
225 Wireless Blvd. Suite 101, Hauppauge, NY 11788
Tel: (631) 543-5355 · Fax: (631) 543-5380
email: info@hia-li.org · http://www.hia-li.org


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