CONTINUING PROFESSIONAL EDUCATION ON-LINE COURSE

Yellow Book Updates for one year beginning the month you start the program

ENROLLMENT FORM

Please type or print legibly

Participant's Name: First_____________________  MI ________ Last ________________________

Primary CPA License No.:  __________________    Texas (check) _________ or
                                                                  Other State (name state) ____________________

Member's Address:  ______________________________   _________________________________
                                  Street or P. O. Box                                       City, State, Zip

Firm Name:_______________________________________________________________________

Firm Address: __________________________________   __________________________________
                           Street or P. O. Box                                              City, State, Zip

Work Telephone No. ___________________________   Work Fax No. ________________________

Member's E-mail Address:  ____________________________________________________________

Fee for One Year of Updates, Providing 24 Hours of Yellow Book Continuing Education:         $100.00

Please print this form, complete it, enclose check in amount of $75.00 payable to the
Texas Association of CPAs, and mail it to:

Texas Association of CPAs
Att'n: CPE Enrollment
PO Box 27115
Houston, TX 77227-7115

Upon receipt of your registration, you will be assigned a user name and password, which will be sent to your e-mail address together with instructions on how to access the site.