At-Large and/or Expired Members List Request Form

Please complete the form below detailing the type of list requested.  The Member Relations Team will respond within 1-2 business days.

If you are unsure which list is the appropriate list for your needs, see the descriptions below. 


  • Internal Listing: We provide just the name, company, city, and state for the members who are within your chapter’s zip code range. This list is typically used to help chapters perform internal audits (along with your In-Chapter report) of their chapter rosters. There is no additional contact information provided and you do not have to submit a request form.


  • External Listing:  We provide the name, company, and physical address for the At-Large SHRM Members who are within your chapter’s zip code range. This listing is used to mail a communication to At-Large members. The request form below and the final version of the communication must be submitted in order to obtain this list. For example, if your chapter is hosting a membership drive and you wish to send flyers out to everyone, you would request this type of listing.


  • Expired Listing: We provide the name and contact information for the members that have expired from your chapter in the 60, 90, or 120 periods. If you are interested in getting information beyond that 120 day mark, you will need to notate that in your request, and a member of our Member Relations Team or your FSD will reach out to you with further questions. 
Your Name*
SHRM At-Large Members within Chapter’s established zip code range(s) or within . (this list will only contain name, company, city, zip) This list will be used only for audit and strategic planning purposes only. The Chapter understands and agrees that (i) they may not use this list for any purpose other than for internal purposes only; (ii) the Chapter will not disclose or distribute the list to any third parties, and (iii) this list is owned exclusively by SHRM. *
Purpose of the mailing - (Choose A or B):*
Intention of mailing – (Choose one) *
Please attach proof of communication to be approved by the member relations team here. *
No File Chosen
File uploads may not work on some mobile devices.
Distribution of Mailing – (Choose A or B)*
Note: The third-party entity’s signature is required.


Use of the SHRM “Affiliate Of” logo:

The chapter agrees to use the “affiliate of” SHRM logo in the manner described in the SHRM Graphics Guide. If the activity is co-developed by a non-SHRM affiliated entity, it must be clear that the agreement is between the chapter and the entity and not SHRM and the entity. 

The chapter and third-party entity understand and agree that (i) they may not use this mail list for any purpose other than that covered in the attached contract; (ii) they will not disclose or distribute the list to any third parties, and (iii) this list is owned exclusively by SHRM.

I would like to request an expired membership roster for the past: *
Cancel
Confirm