Application for Membership ABOUT SSL CERTIFICATES Required Field Contact Information Full Name (To appear on Certificate) First: Middle: Last: Suffix: Nickname: Maiden: Home Information: Address: City: State: zip+4: Phone: E-mail: Employer Information Firm/Company Name: Address: City: State: Zip+4: Mailing Address Address: City: State: Zip+4: Telephone: Fax: Preferred Mailing: Home Work Other If other: Address City State Zipcode+4 Current Employment Public Accounting: Partner Shareholder/Owner Invdividual Practitioner Staff Other: Industry Education Goverment Not working full-time Seeking full-time employment Other Title/Position: Industry Classification: Select One Accounting/Business Services Advertising/Public Relations Agribusiness Broadcasting Chemicals Consulting Distillery Education Engineering/Architect Equine Extractive/Mining/Lumbering Financial Institutions Financial/Investment Services Food Service/Restaurants Food/Kindred Products Government – Federal Government – Local Government – State Holding Company Hospitality/Recreation/Entertainment Hospitals/Healthcare Import/Export Individual Practitioner Insurance/Employee Benefits Law Firm Local Firm Manufacturing – Finished Goods Manufacturing – Raw Materials Media/Communications National/International Firm Non-Profit Organizations Oil/Gas Other Primary/Fabricated Metals Professional Development Public Utilities Publishing/Printing Real Estate/Property Management Real Estate/Construction Recycling/Waste Management Retail/Sales/Service Rubber/Plastics Securities/Brokerage Technology Information Telecommunications Tobacco Transportation Wholesale/Distribution Personal Information Date of Birth: Name of Spouse: College or University (BA): College or University: Graduation Date: Optional Data - Used for statistical Reporting only: Sex: Male Female Origin/Nationality: African-American Asian Caucasian Hispanic Other Professional Information Have you completed all four parts of the Uniform CPA Examination? Yes No If Yes: State: Date: Do you hold a valid CPA certificate from the Kentucky State Board of Accountancy? Yes No If Yes: Certificate#: Date Issued: Are you certified/licensed in another state? Yes No If Yes: State: Certificate#: Date Issued: Have you previously been a member of the Kentucky Society? Yes No If Yes: When? Are you a member of the AICPA? Yes No If Yes: Member# Membership Type Student Member 1) Currently enrolled in a four-year college or university as an accounting student 2) A college graduate of one year or less with most recent degree who has not successfully completed all four parts of the Uniform CPA Examination To apply for student membership, click here Graduate Associate A college graduate of more than one year who is actively pursuing their CPA certificate. Candidate Associate An individual who has passed all four parts of the Uniform CPA Examination, but who has not received approval for certification and/or licensing by any State Board of Accountancy. Inactive Associate A CPA who is not employed full-time (defined as more than twenty hours per week) and who is not seeking full-time employment. Eligibility for inactive status shall be re-established annually at the time of dues billing. Regular Member (1) A certified public accountant under the laws of any state, District of Columbia, or territorial possession of the United States (2) Enjoys all rights and privileges of membership, including the right to vote and to hold any office within the Society organization. Academic Associate A non-CPA teaching tax or accounting related subjects at the college or university level. Professional Associate A non-CPA employed by a CPA firm or an entity controlled by a CPA firm. Temporary Associate An individual employed full-time who has voluntarily surrendered their CPA certificate\license to the corresponding State Board of Accountancy with the certificate/license subject to reinstatement upon completion of the necessary education requirement.. Application Statement Membership dues paid to the Kentucky Society of CPAs are not deductible as charitable contributions for federal income tax purposes. I have read the provisions of Article II of the Bylaws and I agree that, if accepted, I will abide by the Bylaws and Code of Ethics of the Society. I certify by pushing the submit button that the above statements are complete and correct to the best of my knowledge. How Did You Hear About The KSCPA? Society CPE/Event Society Newsletter/Publication Website Employer Radio/Television/Print Ad Trade Show Other
Application for Membership