National Association of Enrolled AgentsApplication

I am applying for:___ Regular Membership (EA # required; membership in state and national required)

___ Associate Status

Name: ______

Firm: ______

Street Address: ______

City, ST Zip: ______

Business Phone: ______Fax: ______

Email: ______

IRS Enrollment Number (if applicable):______PTIN Number:______

National Dues: Membership renews on an anniversary basis. NAEA bylaws require 30 hours of CPE per calendar year, including 2 hours of Ethics. CPE requirements for new members will be pro-rated, 2 hours for each month of membership during the calendar year with at least 2 hours of Ethics. CPE is reported at the time of renewal.

Affiliate Society Dues: If your practice is located in a state listed below, the amount of your Affiliate Society dues is noted. Enrolled Agents must maintain membership in both national and state associations. For information on joining a second state affiliate, please contact NAEA. *Second dues rate listed is for Associates.

___ Alabama Society of Enrolled Agents (AL)...... $25

___Alaska Society of Enrolled Agents (AK)...... $0

___ Arizona Society of Enrolled Agents (AZ)...... $50

___ Arkansas Society of Enrolled Agents (AR)...... $30

___*California Society of Enrolled Agents (CA)...... $170/$119

___ Colorado Society of Enrolled Agents (CO)...... $35

___ Connecticut Society of Enrolled Agents (CT).....$40

___ Florida Society of Enrolled Agents (FL)...... $60

___ Georgia Association of Enrolled Agents (GA)....$55

___ Hawaii Society of Enrolled Agents (HI)...... $40

___ Illinois Society of Enrolled Agents (IL)...... $55

___ Indiana Society of Enrolled Agents (IN)...... $40

___ Iowa Society of Enrolled Agents (IA)...... $25

___ Kentucky Society of Enrolled Agents (KY)...... $25

___ Louisiana Society of Enrolled Agents (LA)...... $30

___ Maryland/DC Society of Enrolled Agents (MD/DC).$35

___ Massachusetts Society of Enrolled Agents (MA)..$50

___ Michigan Society of Enrolled Agents (MI)...... $35

___ Minnesota Society of Enrolled Agents (MN)...... $45

___ Mississippi Society of Enrolled Agents (MS).....$30

Application Fee...... $ 28.00

National Dues...... $185.00

Affiliate Society Dues...... ______

Total Submitted...... ______

 Check Visa/Mastercard/Amex/DC  Cash

CC #: ______Exp:______

Name on Card:______

___ Missouri Society of Enrolled Agents (MO)...... $25

___ Nevada Society of Enrolled Agents (NV)...... $75

___ New Jersey Society of Enrolled Agents (NJ)...... $35

___ New Mexico Society of Enrolled Agents (NM)...... $30

___ New York State Society of Enrolled Agents (NY)....$55

___ North Carolina Society of Enrolled Agents (NC).....$30

___ Northern New England (ME/NH/VT)...... $25

___ Ohio State Society of Enrolled Agents (OH)...... $60

___ Oklahoma Society of Enrolled Agents (OK)...... $50

___ Oregon Society of Enrolled Agents (OR)...... $35

___ Pennsylvania Society of Enrolled Agents (PA)...... $50

___ Rhode Island Society of Enrolled Agents (RI)...... $30

___*South Carolina Society of Enrolled Agents (SC)....$35/$50

___ Tennessee Society of Enrolled Agents (TN)...... $30

___ Texas Society of Enrolled Agents (TX)...... $50

___ Utah Society of Enrolled Agents (UT)...... $40

___ Virginia Society of Enrolled Agents (VA)...... $65/75

___Washington Society of Enrolled Agents (WA)...... $65

___*Wisconsin Society of Enrolled Agents (WI)...... $45/$25

Return to:

National Association of Enrolled Agents

1120 Connecticut Avenue NW, Suite 460

Washington, DC20036-3953

202-822-NAEA (6232); 202-822-6270 fax

Benefits and requirements of membership are outlined
in the NAEA Bylaws. I understand these requirements, and
that this membership may be terminated by me at any
time, or by the Association or Society, according to the circumstances outlined in the Association’s Bylaws.

______

Signature and Date