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| (1) |
Name
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Home Phone
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| (2) |
Business Name
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Bus. Phone
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| (3) |
Cell Phone
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Fax. Phone
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| (4) |
Are you an employee?
Yes / No |
Unit Joining
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| (5) |
Email Address
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| (6) |
Mailing Address
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City
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Zip Code
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| (7) |
Business Address
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City
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Zip Code
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| (8) |
Federal ID #
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Oregon License
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| (9) |
Annual Dues (July 1st - June 30th) $60.00 |
$ |
| (10) |
Months prorated dues @ $5.00 /month |
$ |
| (11) |
Initiation Fee $10.00 |
$ |
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Total Remittance |
$ |
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| (12) |
Have you ever been a member of OSTC?
Yes / No, Comments
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If Yes, How many years ago? |
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| (13) |
How many years have you prepared tax returns? |
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| (14) |
Would you be willing to serve on a committee in OSTC?
Yes / No, Comments
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| (15) |
Do you wish to receive e-mails regarding our organization and tax information?
Yes / No, Comments
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| (16) |
Are you a member of another professional organization?
Yes / No, Comments
If Yes, Name of organization?
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| (17) |
Have you ever been officially disciplined by a regulatory agency?
Yes / No, Comments
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| (18) |
Have you ever been expelled, suspended or disciplined by a professional
organization?
Yes / No, Comments
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I hereby certify that the above statements are true and correct to the best of my knowledge. I will abide by the By-laws and Code of Ethics adopted by the Oregon Society of Tax Consultants. In the event my membership is terminated for any reason, I agree to return my certificate of membership. I hereby receipt for a copy of the
Code of Ethics. |
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| Signature_____________________________ |
Date__________________ |
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