Application for Membership

Please complete all sections. Personal information is used for internal purposes only and will not be sold to outside sources.

Be sure to SIGN your Application for Membership before mailing ...

New Certified Member (possess a valid CPA Certificate)
Former Member Reinstatement (Date of last membership: )
Student Member (accounting major, junior standing or above, at a recognized college or university)
Associate Member (have graduated from college and are currently sitting for the CPA Exam; have passed the CPA Exam, but have not met the one-year experience requirement; or a professional full-time accounting staff employee, working under the supervision of an ASCPA member)

I have passed the CPA Exam:

I am currently sitting for the Exam:

E-Mail Address:  

First Name: 

Middle Name:

Last Name:

Preferred Name: 
(for Name Badges, etc.)


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:

County:

State: 

Zip+4/Postal Code:

Area Code/Phone:

Residence Fax:

House District #: 

Senate District #:

Congressional District #:

Optional Information:
Race/Ethnic Identification:

Foreign Languages: I am fluent in the following foreign languages ;;.

Business/Firm Name:

Which category best describes your type of firm:

 

General Industry:

Public Accounting:

Government:

Education

 

Legal

 

Job Title:

Which of the following best describes your job title:

Areas of Expertise (please limit to 18):

Accounting (General)

Financial Institutions

Practice Management

Accounting Consultation

General Conferences

Public Accounting (General)

Accounting/Auditing

Government (General)

Real Estate Tax

Audit/Compilation/Review

Health Care

Real Estate/Construction

Bankruptcy

Individual Income Tax

Retirement Planning

Benefits

Industry

Small Business

Business Valuation

Information Systems

Specialized Industry

Capital Gains Tax

International Tax

Staff Training

Cash Management

Litigation Support

Taxation (General)

Corporate/Partnership Income Tax

Not-For-Profit

Other (Please Specify):

Education

Pension/Profit Sharing

Estate/Gift Tax

Personal Development

Business Address:

Business P.O. Box:

City:

County: 

State:

Zip+4/Postal Code:

Area Code/Phone:

Extension:

Firm Fax:

Referred By (if any):

Student Members Only

Name of College or University:

Class Level (junior, etc.):

Department:

Street Address:

P.O. Box:

City:

County:

State:

Zip+4/Postal Code:

Department Phone:

Department Fax:

Associate Members Only

Direct Supervisor's Name:
(Must be an ASCPA Member)

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:                              

Original Certificate Number:
State: Date issued:

Reciprocity Certificate Number (Required for certified status if licensed in another state):
State: Date issued:

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.

Payment for the $25.00 application fee must accompany your application. (Excludes student applicants) You will be billed for your annual dues. The Society's fiscal year is April 1 - March 31.

NOTE: IN ORDER TO RECEIVE IMMEDIATE MEMBER DISCOUNT RATES ON ASCPA CPE COURSES, THE APPLICATION MUST BE RETURNED WITH THE $25.00 APPLICATION FEE AND THE APPLICABLE MEMBER DUES (SEE BELOW).

Class A - $220
        CPA - Public Practice Partner / Individual Practitioner

Class B - $180
CPA - Public Practice Employee
CPA - Non-Public Practice Organization Employee
CPA - Inactive (left workforce by choice - indefinite period of time)

Class C - $50
        CPA - Retired (available to members who are at least age 60, or permanently disabled)

Class E - $110
        CPA - Non-Arkansas Resident (Live & Work Out of Arkansas)

Class F - $75
        CPA - Unemployed (Temporary Status - 1 Year Maximum)

Class G - $25
        Non-CPA - Student

Class H - $80
        Non-CPA - Associate

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 signature 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