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* Mandatory fields

*First name

*Last name

*e-Mail

Phone

Order Date

Billing Last Name

Billing First Name

*Billing Company Name/Details

*Email Address

*Billing Address Line 1

Billing Address Line 2

*Billing City

*Billing State

*Billing Postal Code

*Billing Phone

Order Total

SHRM Member #

*Amount ($USD)

Payment frequency

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Comment

Kern County Society for Human Resource Management.

P.O. Box 2802 Bakersfield, CA 93302