Offline Application Name Tell Us About You Full Name * Address * City/State/Zip * Email * Date of Birth * College/University Degree Minimum 3 years tax/accounting experience Yes No Are You... Enrolled to Practice before the IRS? yes No If so, IRS # Certified Public Accountant? Yes No Licensed Public Accountant? Yes No If Yes: Accredited by the Accreditation Council of Accountancy and Taxation? Yes No If Yes: In Accounting In Taxation Both Are you a member of NSA? Yes No References Reference Name * Reference Address * Tell Us About Your Practice About Practice Sole Practioner Partner Employee Corporate Officer Student Retired Business Name * Adress * City/State/Zip * Are you engaged in any other trade, business, or profession Yes No If yes, is more than 50% of your income from the public accountant/tax profession? Yes No Phone # * P.O. Box How many years experience in accounting/tax profession? * I hereby certify that the accompanying statements are correct to the best of my knowledge and belief. I also certify that I have never been suspended or expelled from any professional organization, and that I have not suppressed any information which might have bearing upon this application. As an active member, I agree to maintain the CPE requirements of the Society to maintain my membership. I further certify that if I am accepted as a member, I will abide by the By-Laws and Administrative Rules of the Montana Society of the Public Accountants and will practice in strict conformity with the Code of Ethics adopted by the Society. In the event my membership terminates for any reason, I agree to return my Certificate of Membership