Student Group Membership - Nalgene Water Bottle Fall Promo

School Name*

Point of Contact*

First Name

Last Name

Point of Contact E-mail *

School Address*

Address Line 1

Address Line 2

City

State/Province

ZIP / Postal

Country

Number of Student Vouchers *

Payment Instructions

ACH/Wire Check Credit Card

Customer ID (For Internal Use Only)

For Internal Use Only

For Check payments: Checks are payable to “SHRM” in US dollars only.

Mail checks with order summary to:

SHRM

PO Box 79482

Baltimore, Maryland 21279-0482

For Wire and ACH payments:

Send Wire or ACH to: Society for Human Resource Management (SHRM)

SHRM’s Bank is: SunTrust Bank

SHRM’s Bank Routing #: 061000104

SHRM’s Account #: 1000055640022

Swift Code: SNTRUS3A

Reference Line: Student Voucher Program(School Name)

Thank you for choosing the Group Membership + SHRM21 Registration program. Please provide a phone number below and a representative will contact you for payment.*