YES! I WANT TO INVEST IN A FUTURE WITH NO LIMITS!

Enroll me as an AICPA Student Affiliate Member Today!

Please print this form, complete ALL of the required information, and fax or mail it to the AICPA at the address/fax number at the bottom of this form. Please do not e-mail the information at this time; we will offer that service soon.

Name:
E-mail address:
Date of Birth:

Please check your preferred mailing address.

Home Address
Address:
City:
State:
County:
Zip Code:
Telephone:

School/Firm/Company
School/Business Name:
Address:
City:
State:
Zip Code:
Telephone:
Beta Alpha Psi Chapter No: (complete this field only if you are a Beta Alpha Psi member)

Student:
I am a freshman sophomore junior senior graduate student

Expected Graduation Date:
(Month/Year)

CPA Candidate:
I am currently acollege graduate who is waiting to pass the CPA Exam.

I have/will sit for the CPA Exam in:
(State)
(Date)

Member Dues:
$35 for Students
$35 for CPA Candidate
I am enclosing a check in the amount of
$

MasterCard Visa Discover American Express Diners Club
in the amount of $

American Express and Diners Club

Name as it appears on the card:
Billing Address:
Card Number:
Exp. Date:
Signature:
A COPY OF STUDENT I.D. MUST ACCOMPANY THE APPLICATION
Note: Membership will not be processed without payment, and there are no membership dues refunds. You may remain a Student Affiliate as long as you are a full time student and for five years after graduation and or completing graduate school to fulfill the 150 hour requirement (if applicable). Upon meeting the eligibility requirements to sit for the CPA exam, you must sit for the CPA exam at least once each year to remain in this membership category. No one may remain a Student Affiliate for longer than a total of ten years, and existing CPA's may not apply for this membership even though they may be students. Student Affiliates will not have voting rights and may not generally serve on AICPA Committees. Only students residing in the U.S. are eligible for membership.
Applicant's Statement: To the best of my knowledge and belief, the information contained herein is true and correct. I agree to abide by the decisions of the Board of Directors as to the disposition of this application. If admitted as an Affiliate, I agree to be governed by and to comply with the Bylaws and Code of Professional Conduct of the AICPA
Date:_________________ Signature:____________________________________________________

Please mail with payment or fax with credit card information to: American Institute of Certified Public Accountants Harborside Financial Center PO Box 2212 Jersey City, NJ 07303-2212 Fax: 800-362-5066 Attn: Service Center

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