MSCPA Membership Application

Take advantage of all the benefits and opportunities afforded by MSCPA membership!

Please fill out form completely:

E-Mail Address:     

FULL NAME
First:              
Middle:             
Last:               

Name (As you would like it to appear on your Membership Certificate):
                    

Home Address:       
City:               
State:              
Zip/Postal Code:    
Area Code/Phone:    

PERSONAL INFORMATION

Friends call me:    
Full Name of Spouse:
Date of Birth:      
Place of Birth:     

CURRENT EMPLOYMENT

Sector:            Public Accounting
                   Commerce or Industry
                   Other:

Firm/Company:       
Position/Title:     
Business Address:    
City:               
State:              
Zip/Postal Code:    

Area Code/Phone:    
Fax:                

Employed here since:

SOCIETY MAILINGS

Mail to:(please check one)   Business  Home

PREVIOUS EMPLOYMENT INFORMATION

Please provide name, city and state of last three employers and dates of employment.Do not include present employer.:

Employer:   
City:       
State:      
Position:   
Dates from: 
to:         

Employer:   
City:       
State:       
Position:   
Dates from: 
to:         

Employer:   
City:       
State:      
Position:   
Dates from: 
to:         

MEMBERSHIP INFORMATION

Membership in Accounting, other professional or civic organizations
(please indicate if past or present status)

Name of Organization: 
Office Held:          
Membership Status: Past  Present

Name of Organization: Office Held: Membership Status: Past Present Name of Organization: Office Held: Membership Status: Past Present Member of American Institute of Certified Public Accountants? Yes No

Were you ever a member of the Mississippi Society? No Yes
If yes, when was your membership terminated?
Also, please explain conditions under which it terminated:

EDUCATION

High School:       
Degree obtained:   

College/University:  
Degrees obtained:  
Date:              
                   
Date:                

College/University:  
Degrees obtained:  
Date:              
                   
Date:              

CERTIFICATE INFORMATION

I hold  a Mississippi Certificate: Yes No  
If yes, Mississippi Certificate#:   
Date issued:                        
If no, Other State of Certification:
Cert. #:
Date:   

ORIGINAL State of Certification: Cert. #: Date:

MEMBERSHIP CATEGORIES & ANNUAL DUES

Requirements for Membership
1. A prospective member must hold a CPA certificate and be in good standing with a State Board of Public Accountancy.

2. A prospective member must file an application with the Secretary which includes an endorsement by one member of the Society. The application is then reviewed by the Board of Governors and the General Membership. If no objections are filed, the member is elected.

1. Member who has held a certificate for 3 years or more in (please specify):

• Public Practice........$160.00
  Industry...$160.00
  

2. Member who has held a certificate for less than 3 years in (please specify):

• Public Practice........$115.00
  Industry...$115.00
  

Member who is not engaged in any public practice...........$120.00

Non-Resident Member......$90.00

Retired Member(earning no fee from public practice)......$40.00

APPLICANT STATEMENT

I, the undersigned, apply for admission to the Mississippi Society of Certified Public Accountants, and I agree to abide by the decision of the Board of Governors as to the disposition of this application. I have read, and understand, the Code of Professional Ethics as set forth in the Bylaws of the Society, and I agree, if elected, to be governed by the Charter of Bylaws of the Society.

I certify that the statements contained in this application are correct to the best of my knowledge and belief; and that I have never been convicted oby any court or other body of any crime, misdemeanor or discreditable act; that I have never been suspended or expelled from any professional organization, except as noted at the end of this application, and that I have not suppressed any information which might have a bearing on the acceptance or rejection of this application.

Signature:___________________________________  Date:_____________
                         (if printed or faxed)

ENDORSEMENT OF SOCIETY MEMBER

Sponsor's statement: I have been personally acquainted with the applicant for:
(months/years, etc.).

Full Name of Sponsor:

Signature:___________________________________  Date:_____________
                         (if printed or faxed)

If you have ever been suspended or expelled from any professional organization, please explain conditions under which it terminated:

How to Apply:

• Return the completed application form, along with a payment for $30 initiation fee.
• Do not include a dues payment with this application. An invoice will be mailed to you after acceptance into the Society.

   

  Fill out this form and print it. Send printed application and application fee to:
  

  Mississippi Society of CPAs

  306 Southampton Row
  
  Ridgeland, MS  39157
  

         Questions? Call the Mississippi Society of Certified Public Accountants at (601)856-4244. or email us.

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