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You will be charged a one-time application fee of $25.

Member Profile
Application Type	Regular (Oahu) Regular (Neighbor Island) Associate Committee Affiliate Student Mainland International Reinstatement Reclassification
First Name*
Middle Initial
Last Name*
Nickname
Address*
City*
State*
Zip*
Home Phone†
Home Fax
Home E-Mail
Gender*	Male Female
Date of Birth*
Spouse
Field of Employment
Preferred Mailing Address	Home Office
Business/Employer Information
Business Name
Type of Firm	Choose One Public Accounting Business & Industry Government Education
Postition/Title
Address
City
State
Zip
Business Phone†
Business Fax
Business E-Mail
Business URL
Certification Information
State of Original Certification
Certified In State/Out of State	Choose One In and Out of State In-state only Out-of-state only Yes
Certificate Number
Date Issued
Hawaii Certificate Number
Date Issued
College/University
Professional Designations
Are you an AICPA Member?	Yes No
AICPA Member Number
Other Professional Associations
Exact Name to be Printed on Certificate

* = required fields

† = At least one required