Iowa Society of Licensed Public Accountants

IOWA SOCIETY OF LICENSED PUBLIC ACCOUNTANTS APPLICATION FOR MEMBERSHIP
I hereby make membership as a member in the Iowa Society of Licensed Public Accountants and agree to observe and be governed by the bylaws and rules of ethics and professional conduct of the Society.

Name
Last First Middle Initial

Business Affiliation
Company Name
Position
Street
City & State Zip
Phone Fax E-Mail

Mailing Address
Street
City & State Zip
Phone Fax E-Mail

Which Address would you like mail sent to?
Business Address
Mailing Address

Date & Place of Birth

Iowa LPA
Certificate Number Date of Issue Permit Card No.

Employment History (in Chronological order) for past 10 years.
Employer #1 Position
Address Date From-To

Employer #2 Position
Address Date From-To

Employer #3 Position
Address Date From-To

Employer #4 Position
Address Date From-To

Number of years experience in accounting

Are you Engaged in full-time public practice?
Yes
No

If approved for membership, would you be willing to serve on a committee?
Yes
No

I will abide by the Constitution and By-Laws of the Iowa Society of Licensed Public Accountants, and will conform with Rules of Professional Conduct, and I agree to return to the Iowa Society of Licensed Public Accountants my membership certificate in the event of termination of my membership for any reason.
Date Initials Title