Membership Application

Member Classification

Have you previously been a member of the OSCPA?

I am applying for membership as *  


General Information

First name or initial *


Middle name or initial


Last name *


Maiden name


Suffix (Sr., III, etc.)


Other credentials
(MBA, Ph.D., etc.)



Date of birth (mm/dd/yyyy)


Gender *


Home Information

Address *


P.O. Box (or street cont.)






ZIP code


Foreign address **

If not living in the U.S.A., choose foreign address from state drop down, and enter province, country, postal code in the Foreign Address box.

Contact Information

Home phone


Mobile phone




Preferred e-mail


Secondary e-mail


Send all mail to my *


Do you want to receive printed CPE mailings?

Do you want to receive CPE email?

Terms and Conditions

To the best of my knowledge and belief, the information contained herein is true and correct. By completing this application, I hereby represent to the OSCPA that I will be bound by the Society's Bylaws and Code of Professional Conduct.