Name:

Nickname:

Birth Date:

Home Address:

City:

State:

Zip:

Phone:

E-mail:

School Name:

School Residence Address:

City/State/Zip

I'm a Freshman Sophomore Junior Senior Other
Expected Graduation Date:

Please send my mail to Home School

I understand and agree that as a student member of the Society of Louisiana CPAs that I will be bound by the
Society's code of conduct.

Any reference to your membership in the Society of Louisiana CPAs must clearly identify you as a student member. Any use of the student membership in a manner that is intended to mislead the public will result in the membership being revoked.

LCPA offers college student membership to any student who is

• Enrolled in a Louisiana university or college working towards the 150-hour requirement to become a CPA, or
• Enrolled in an Uniform CPA Exam preparation course, or
• Sitting for the Uniform CPA Exam

Signature_____________________________________

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Make checks payable to LCPA. Send completed application form and $10.00 annual membership fee by mail to:
LCPA
2400 Veterans Memorial Blvd., Suite 500
Kenner, LA 70062-4739