A Regional Affiliate of the American Society 2015 Membership Application

A Regional Affiliate of the American Society 2015 Membership Application

of Pension Professionals & Actuaries

1. Personal Information:(Please Print)

Full Name (First M Last, Suffix) / Designations (QPA, MSPA, EA, etc.)
AccountantActuaryAttorneyExecutive/OfficerManager/AdminManager/MarketingManager/Product SalesManager/TechnicalStaff/AdminStaff/MarketingStaff/Product SalesStaff/TechnicalOther
Position/Title / *Position Category / Yrs of Experience / ASPPA Member ID

2. Contact Information:(Please Print)

Your contact information will not be shared with anyone outside ASPPA. Your home contact information will be used to track the congressional districts in which our members reside or if we are unable to contact you at your place of business.

AccountingActuarial/Employee Benefits ConsultingBank/S&LComputer/SoftwareEducationalInsuranceInvestment AdvisoryLawRecordkeepingTPAOther
Business Name / Business Type**
Business Address / BusinessCity, State, Zip
Business E-Mail / Business Phone / Business Fax
Home Address / HomeCity, State, Zip
Home E-Mail / Home Phone / Home Fax

Note: Please use the reverse side and additional pages for additional members from the same company

3. Member Information: Provides ABC of Greater Twin Citiesmembership throughDecember 31, 2015

Note: Memberships are not transferable

ASPPA Member$ 25.00 / Corporate Membership$250
Non- Membership$ 50.00

Membership Costs:

Would you be interested in assisting on any ABC projects? Yes No

4. Payment Information: Total Payment of $

Method of Payment: Check enclosed - Payable to “ABC of Greater Twin Cities” Credit Card:

Credit Card #: / Exp Date:
Signature: / Name on Card:

Please return a completed application with payment to the ASPPA-ATTN:Stacia

Email: -Physical Address: 4245 N Fairfax Dr # 750, Arlington, VA 22203

For further information, please visit our website at:

*Position Categories: Accountant, Actuary, Attorney, Executive/Officer, Manager/Admin, Manager/Marketing, Manager/Product Sales, Manager/Technical, Staff/Admin, Staff/Marketing, Staff/Product Sales, Staff/Technical, Other.

**Business Types: Accounting, Actuarial/Employee Benefits Consulting, Bank/S&L, Computer/Software, Educational, Insurance, Investment Advisory, Law, Recordkeeping, TPA, Other.

Additional Membership Registrations

AccountantActuaryAttorneyExecutive/OfficerManager/AdminManager/MarketingManager/Product SalesManager/TechnicalStaff/AdminStaff/MarketingStaff/Product SalesStaff/TechnicalOther
Full Name (First M Last, Suffix) / ASPPA Member ID / Position/Title / *Position Category / Yrs of Exp
Business E-Mail / Business Phone / Business Fax / Designations
Home Address / HomeCity, State, Zip
Home E-Mail / Home Phone / Home Fax
AccountantActuaryAttorneyExecutive/OfficerManager/AdminManager/MarketingManager/Product SalesManager/TechnicalStaff/AdminStaff/MarketingStaff/Product SalesStaff/TechnicalOther
Full Name (First M Last, Suffix) / ASPPA Member ID / Position/Title / *Position Category / Yrs of Exp
Business E-Mail / Business Phone / Business Fax / Designations
Home Address / HomeCity, State, Zip
Home E-Mail / Home Phone / Home Fax
AccountantActuaryAttorneyExecutive/OfficerManager/AdminManager/MarketingManager/Product SalesManager/TechnicalStaff/AdminStaff/MarketingStaff/Product SalesStaff/TechnicalOther
Full Name (First M Last, Suffix) / ASPPA Member ID / Position/Title / *Position Category / Yrs of Exp
Business E-Mail / Business Phone / Business Fax / Designations
Home Address / HomeCity, State, Zip
Home E-Mail / Home Phone / Home Fax
AccountantActuaryAttorneyExecutive/OfficerManager/AdminManager/MarketingManager/Product SalesManager/TechnicalStaff/AdminStaff/MarketingStaff/Product SalesStaff/TechnicalOther
Full Name (First M Last, Suffix) / ASPPA Member ID / Position/Title / *Position Category / Yrs of Exp
Business E-Mail / Business Phone / Business Fax / Designations
Home Address / HomeCity, State, Zip
Home E-Mail / Home Phone / Home Fax

Additional Membership Registrations