P. O. Box 284
Charleston, WV  25321
(304) 342-4441

WVPAA Membership Application

Name _______________________________________________________________
Please show name above as you wish it to appear on membership certificate.

I am a: ___Sole Practitioner ___ Partner ___ Corporate Officer ___ Employee 

No. of years of experience in: Public Practice _______ Private Firm ______ Other ______ 

I received a: baccalaureate or associate degree
    from ____________________________________________ in year _______
    If the degree is other than in accounting, how many hours in accounting do you have?
    _________hours. 

Persons applying for membership in the West Virginia Public Accountants Association must meet at least one of the qualifications listed below: 

Member Qualifications- Please mark appropriate qualifications. Mark all that apply. 

___ I hold a valid permit/license as a Public Accountant. 
        State & Registration No. _____________

___ I hold a valid permit/license as a Certified Public Accountant. 
        State & Registration No. ____________ 

___ I am enrolled to practice before the IRS. 
        Registration No. ______________________

___ I am accredited by the ACAT in/as:
         ___ Accountancy ___ Tax Preparer ___ Tax Advisor ___ Other ___________________ 

___ I am a Certified Financial Planner

___ I offer accounting and/or tax services to the public, I have three years of experience or more or equivalent, and I maintain an office to provide these services. 

___ I am an employee of an accounting firm and do not qualify under any of above. 

___ I am an educator teaching at _____________________________________________

___ I am an accountant in government service. 

___ I am an accountant employed by a private organization.

___ I am a FULL time student studying accounting at _____________________________
        (Qualifies for student dues fee of $10.00)

I hereby state that the accompanying statements are true and correct to the best of my knowledge and belief. I further state that I will abide by the Constitution and By-laws of the Association and will practice in strict conformity with the Code of Ethics and Rules of Professional Conduct adopted by the Association. 

Date ______________ Signature of Applicant _____________________________

___ Active Membership                ___ Student Membership
Annual Dues $100.00                     Annual Dues $10.00

Sponsored by __________________________________________

Please print, complete, and mail completed application and proper fees to:

WVPAA
P. O. Box 284
Charleston, WV  25321

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