MEMBERS (Active or Associate)
Meet any of one of the following requirements:
Enrolled Agent # CRTP # CPA or Attorney #
PTIN #
ACAT Accredited: ¨ Accountancy ¨ Taxation ¨ Both
NEW MEMBER RATES:
DUES INITIATION FEE
$175.00 $25.00
I hereby state that the accompanying statements are correct to the best of my knowledge and belief. I further state that I will abide by the Bylaws of
the Society and will practice in strict conformity with the Code of Ethics adopted by the Society.
Applicant Signature Date
Payment must accompany this application
Check # or ¨ Visa ¨ Mastercard
Credit Card # Exp. Date Sec. Code
Billing Address
Applicant Signature Date
CHAPTER AFFILIATION
I would like to be afliated with the following chapter:
¨ Central Valley ¨ Orange County ¨ San Diego ¨ San Gabriel Valley
¨ Greater Long Beach ¨ Orange County South ¨ San Diego East County ¨ San Jose
¨ Inland Empire ¨ Orange County Wine Country ¨ San Diego North County ¨ Temecula Valley
¨ Los Angeles ¨ Sacramento ¨ San Francisco Bay ¨ Member-at-Large
320 Pine Ave, Suite #1050, Long Beach, CA 90802
Telephone 949-715-4192
Fax 949-715-6931
info@cstcsociety.org
www.cstcsociety.org
MEMBERSHIP APPLICATION
Name Name Badge
Address
City State Zip
Cell # Work # Fax #
Email Preferred Chapter
Chapter Approval Required for Associate Members
Authorized Chapter Signature
Recruited by:
Rev 1/2019
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