Bill Card Request

Bill Card Request

Please use this form to order a new or replacement card for your team
SHP University Training
THE FOLLOWING SECTIONS MUST BE COMPLETED BY THE CHAPTER PRESIDENT.

Before continuing please make sure the new card holder has an active SHP email address, has completed the SHP University course on Bill, http://shpuniversity.shpbeds.org (log in with google and use your SHP email address), and has read and understands the following document. You will need their mailing address, and date of birth to complete this request.

SHP Bill Policy and Procedure
Your Full Name*

First NameLast Name
Your SHP Email*
example@shpbeds.org
Has the new card holder completed the Bill training in SHP University?*

YesNo
Has the new card holder been given and read through the Bill Policy and Procedures document?*

YesNo
The SHP University course must be completed prior to ordering a card.
The new cardholder must read through the Bill Policy and Procedures document prior to ordering a card.
Cardholder Information
Is this a replacement card or one for a new team member?*

Replacement cardCard for a new team member
Card Holder's Full Name*

First NameLast Name
Card Holder's Address*

Street Address

Street Address Line 2

CityState

Zip Code
Cardholder's Phone Number*
Please enter a valid phone number.
Card Holder's SHP Email*
example@shpbeds.org
Cardholder's Chapter*
Card Holder's Date of Birth*

MonthDayYear
Date
Card Holder's SHP Region*
Should be Empty:

SHP University Training