MSCPA Membership Application

for Associate Membership


Take advantage of all the benefits and opportunities afforded by being an Associate Member of the MSCPA.

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:


EDUCATION

High School:       
Degree obtained:   

College/University:  
Degrees obtained:  
Date:              
                   
Date:                

College/University:  
Degrees obtained:  
Date:              
                   
Date:


Requirements for Membership as an Associate Member:

An associate member shall be either:

1. a professional associate who is a non-CPA working for a CPA firm, a law firm, in industry or in other segments of the business community.

2. an academic associate who is a non-CPA teaching tax or accounting related subjects at the college or university level.

3. a candidate associate who is a person, who has passed the CPA examination, but has not received his/her CPA certification.

4. a temporary associate who is a person working full-time, but who has voluntarily surrendered his/her CPA certificate to a State Board of Accountancy, with the certificate subject to renewal upon completion of a specified education requirement.

5. an inactive associate who is a regular member who is not employed full-time (more than 20 hours per week) as of July 1 each year, and who is not actively seeking full-time employment. Eligibility for inactive status shall be re-established annually, at the time of dues billing.

Associate members hold no voting rights and may not hold elective office


APPLICANT STATEMENT

I, the undersigned, apply for admission to the Mississippi Society of Certified Public Accountants as an Associate Member, and I agree to abide by the decision of the Board of Governors as to the disposition of this application. I

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:

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


Return to Top

Member Services
Member Services