Oregon Society of Certified Public Accountants

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Student Membership Application

Applicant And Employment Information

* Required fields are indicated with red asterisk.

Student dues are $35 a year

Have you previously been a member of the OSCPA? * Yes No

How did you hear about the OSCPA?

PERSONAL INFORMATION
Male	Female *
First Name: *
Middle Name: *
Last Name: *
Suffix:
Nick Name:
Prior Name:
Birthdate for statistical purposes only:	/ /
Ethnic/Race Identification (optional):
Street Address: *
PO Box (if applicable):
City: *
State/Province: *
Zip/Postal Code: *
PO Box Zip (if applicable):
Home Phone:
Mobile Phone:
Email: *
Mailing Preference:	Home Office
Email in member directory:	Don't Display Display
SCHOOL INFORMATION
I am: *	An Undergraduate/Post Baccalureate Student A Graduate School Student
College Or University: *
Anticipated Graduation Date (Month/Year): *	/
BUSINESS INFORMATION (if applicable)
Business Name:
Street Address:

City:
State/Province:
Zip/Postal Code:
Phone Number:
Fax Number:
Job Title:

OSCPA Communication Preferences

The OSCPA frequently communicates with its members using electronic messaging which may include commercial* content. Please select your communication preferences below.

Mail

Fax

Email

Exclude from CPE/Self Study mailing = Commercial*
Exclude from non-CPE mailing = Non-Commercial**
* Commercial content includes notification of fee related CPE Programs and other Society events, products and services.
** Non-Commercial content includes OSCPA magazine, notices of professional issues and news, volunteer communications, etc.

The OSCPA membership contact information, in printed or electronic form, shall not be made available to any business or individual. The Board of Directors may take exceptions for charitable organizations, civic groups or accredited academic institutions, if appropriate. However, the OSCPA must remain in compliance with all state and federal rules and regulations that may prohibit the release of member information.

If submitting this Application online, I expressly acknowledge that my checking this box and submitting this Application is intended by me to constitute an electronic signature of this Application as that term is defined in Oregon's Uniform Electronic Transactions Act.