Oregon Society of Tax Consultants, Inc.

Please complete all applicable lines
REGULAR - (Full dues)
ASSOCIATE - (Full dues)
CONTRIBUTING - (1/2 dues)

(1) Name
Home Phone
(2) Business Name
Bus. Phone
(3) Cell Phone
Fax. Phone
(4) Are you an employee?
Yes / No
Unit Joining
(5) Email Address
(6) Mailing Address
Zip Code
(7) Business Address
Zip Code
(8) Federal PTIN #
Oregon License

(9) Annual Dues (July 1st - June 30th) $60.00 $
(10) Months prorated dues @ $5.00 /month $
(11) Initiation Fee $10.00 $
  Total Remittance  $

(12) Have you ever been a member of OSTC?
Yes / No,  Comments
  If Yes, How many years ago?
(13) How many years have you prepared tax returns?
(14) Would you be willing to serve on a committee in OSTC?
Yes / No,  Comments
(15) Do you wish to receive e-mails regarding our organization and tax information?
Yes / No,  Comments
(16) Are you a member of another professional organization?
Yes / No,  Comments
If Yes, Name of organization?
(17) Have you ever been officially disciplined by a regulatory agency?
Yes / No,  Comments
(18) Have you ever been expelled, suspended or disciplined by a professional
Yes / No,  Comments

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.

Signature_____________________________ Date__________________

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Mail or Fax to our current Treasure listed at http://www.ostcinc.org/officers.htm.

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