WYOMING ASSOCAITION OF PUBLIC ACCOUNTANTS

Incorproated under the Laws of the State of Wyoming

INVITATION FOR MEMBERSHIP

*Please show your name above as you wish it to appear on your membership Certificate*

Mailing Address

City

State

Zip

Sole Practitioner

Partner

Employee

Corporate officer

Name of Firm

Business Phone

(       )

Name of Partner(s)

Number of Employees

No. of years experience in accounting

No. of years experience in public practice

Are you enrolled to proctice before the IRS?

____  YES

If Yes, enrollment Number ___________

Are you a Licensed or Registered Public Accountant?  ___________ Yes

If yes Lic. Or Reg. No. and State ______________________________________

Are you a certified Public Accountant?  ______ Yes

If yes, CPA Number and State ________________

Are you accredited by the Accreditation Council for Accountancy in ____ Accountancy

____ Taxation

Education : Degree(s) ______     Year(s) ______      School(s) _____________________________________

National or State accounting organizations in which you now hold membership ________________________

Continueing Professional Education Requirement

As an active member, you are required to demonstrate that you have at least 32 hours of continuing professional education (CPE)

in the two years following acceptance and each 2 year period thereafter.

I hereby state that the accompanying statements are correct tot eh best of my knowledge and belief.  I further state that I will

abide by the Constitution and Bylaws of the Society and will practice in strict conformity with the Code of Ethics and Rules

of Professional Conduct adopted by the Society.

Date _________________________

Signature of Applicant ___________________________________________

*ANNUAL DUES*

Active, Over Two Years in Practice

$100.00

Initial Admin Fee

$10.00

Active, Less Than 2 Years in Practice

$60.00

Associate

$40.00

Student

$5.00

Life members, Retired Members, and Honorary Members Dues Established by Board of Directors

IMPORTANT NOTE:  A copy of your professional stationery or business card must accompany this application for

active membership.

Mail To:

WAPA

Sponsor (optional)

P O Box 327

Sheridan, WY  82801

Office Use Only

Amount __________

Date Received _________________

Certificate Number _______________