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LEADERSHIP ACADEMY
First Name
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Last Name
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Designation(s)
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SHRM-CP
SHRM-SCP
PHR
SPHR
GPHR
CEBS
No Designation
Other
Other
Company
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Title/Position
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Street Address
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Address Line 2
City
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State
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Zip Code
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Preferred Phone
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Mobile Phone
Email Address
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Twitter Handle
List Special Dietary or Accommodation Requests
Please list your jacket size
Company Size
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0-50
51-250
251-500
501-999
1,000+
Industry
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Number of Years in HR
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Are you a SHRM member
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Yes, SHRM Member
Yes, SHRM Student
Not a SHRM Member
Chapter Affiliation
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Central Kansas SHRM
HR Management Network
HR Professional Assn. of Greater Emporia
Jayhawk Chapter SHRM
Salina HR Management Assn.
SHRM of Johnson County
SHRM of SouthWest Kansas
Southeast Kansas HRA
SHRM-Topeka Chapter
Western Kansas HRMA
Wichita Chapter SHRM
Other
Other
2025 Volunteer Position (You MUST be on the State Council or a Kansas Chapter Board to attend)
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If you are a State Council member, do you plan to attend the State Council board meeting on December 5th?
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Yes, I will attend the State Council board meeting in person
No, I am not able to attend the State Council board meeting
I am not on the State Council
Will you be joining us for a networking social event on Thursday evening?
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Yes
No