ASA Membership

Name *

First Name

Last Name

Business Phone *

(###)

###

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Home Phone *

(###)

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Business Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Sole Practitioner

Partner

Employee

Corporate Officer

Are you a Licensed, Registered or Certified Public Accountant?

Yes

No

Are you an Accredited Public Accountant? *

Yes

No

Are you an Enrolled Agent? *

Yes

No

Do you hold an Associate or Baccalaureate degree with a minimum of 24 semester hours in accounting? *

Yes

No

Are you engaged in any other trade or business?

Yes

No

Confirmation

By checking this box, I hereby state that the accompanying statements are correct to the best of my knowledge and belief. I further state that I will abide by the Constitution and By-Laws of the Society and will practice in strict conformity with the Code of Ethics and Rules of Professional Conduct adopted by the Society.

Membership Level purchased below:

ASA Annual Membership Dues

ASA Retirement Membership Dues

ASA Diamond State Membership Dues