Membership Application

Apply using this form or call (800) 733-8272 to join over the phone. (Phone applications are accepted Monday – Friday, 9 a.m. – 5 p.m.)

Member Classification

Have you previously been a member of the VSCPA?

I am applying for membership as *  


General Information

First name or initial *


Middle name or initial


Last name *


Suffix (Sr., III, etc.)


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



Date of birth (mm/dd/yyyy) *


Gender *


Ethnic origin

Date of undergraduate
graduation (mm/dd/yyyy) *


Home Information

Address *


P.O. Box (or street cont.)


City *



ZIP code


Foreign address **

** If not living in the U.S., choose "Foreign Address" from the "State" drop down and enter province, country, postal code in the "Foreign Address" box.

Contact Information

Home phone


Mobile phone




Preferred e-mail *


Send all mail to my *


VSCPA Chapter Preference

Please select your VSCPA chapter preference
Chapter Map

Preferred chapter *


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 VSCPA that I will be bound by the Society's Bylaws and Code of Professional Conduct.