Student Application

New Student Member (accounting major, junior standing or above, at a recognized college or university)

E-Mail Address
First Name
Middle Name
Last Name
Preferred Name (for name badges)
Gender Female  Male
Birth Date
Spouse Name
Are you a member of AICPA?   Yes  No  Member #:
Mailing Preference   Residence  Firm
Residence Address
Residence P.O. Box
City
State
Zip+4
County
Area Code/Phone
Residence Fax
House District #
Senate District #
Congressional District #
Business / Firm
Which of the following categories best describes your type of firm:  
  General Industry
  Public Accounting
  Government 
  Education
  Legal
Job Title
Which of category best describes your job title:
Business Address
Business P.O. Box
City
State
Zip+4
County
Area Code/Phone
Extension
Firm Fax
Referred By (if any)
Name of College or University
Class Level (junior, etc.)
Department
Street Address
P.O. Box
City
State
Zip+4
County
Department Phone
Department Fax

OPTIONAL INFORMATION:

Race/Ethnic Identification
Foreign Languages

By signing this application, I hereby represent to The Arkansas Society of CPAs that I will be bound by the Society's Bylaws and Code of Professional Conduct. I further agree to comply with the rules of ethical conduct contained in the current version of the AICPA publication entitled, "Professional Standards, Ethics, Bylaws, Quality Control," the acceptance of which should not be construed as a denial of the existence of other standards of conduct not specifically mentioned.

Your Signature:          _______________________________________
Date:                              

Please check here if you are interested in serving on a Society committee or task force.

Selecting a Chapter.

Please indicate the chapter you wish to join. If you do not make a selection, you will be assigned to the chapter in which your preferred mailing address is located.

Dues Schedule

Please check the appropriate dues class below. If your classification changes during the year (for example, when you receive your CPA certificate, or when you change employers or employment status), you are responsible for contacting the Society and keeping your Society records up-to-date. The Society's fiscal year is April 1 - March 31.

Class G - $25.00
    Non-CPA Student

Payment Method (select one):

Check mailed, above form sent via Fax.
Check enclosed with copy of above.
Credit Card Payment with Application:

Number
Expiration Date
Cardholder Name

Please mail or fax this completed form, along with original signatures and payment to:
Arkansas Society of CPAs
11300 Executive Center Drive, Little Rock, AR 72211-4352
(501) 664-8739 / (800) 482-8739 in Arkansas
FAX: (501) 664-8320
E-MAIL: ascpa@arcpa.org
www.arcpa.org

FOR ASCPA USE ONLY:

President________________________________________ Date_______________

Secretary________________________________________ Date_______________

Contact the Arkansas Society of CPAs at bangel@arcpa.org or 501-664-8739.
Send mail to ssubedi@arcpa.org with questions or comments about this web site.
Copyright © 2000 Arkansas Society of Certified Public Accountants
Last modified: April 25, 2008