Membership Application

The National Society of Accountants for Cooperatives (NSAC) is a professional society that offers maximum benefit to members at minimal cost with a membership plan designed for your specific needs.

All memberships are individual memberships and are not transferable. To be eligible for regular membership, an individual shall be employed by or affiliated with a cooperative association, be engaged in providing professional services for cooperatives, or shall otherwise be engaged in the furtherance of cooperative principles. The national annual membership service fee is $175.00 and covers 12 months of membership from the date enrolled. The application will be considered accepted when payment is received for national membership fees plus applicable chapter dues (listed below).

Chapter membership is required as a condition of membership in NSAC. Chapters have been organized by region as set forth below. Members usually affiliate with the chapter covering the area in which they live or work. However, NSAC recognizes that for professional, geographic or other reasons members may prefer to affiliate with a different chapter or with more than one chapter. The Electric Cooperative Chapter is a national chapter. Those affiliated with an electric cooperative usually join this chapter and the geographic chapter in their area.

General Information

First Name

Middle

Last Name

Salutation (name you prefer to be called by if different from above)

I am:

Male

Female

I was referred to NSAC by (member name):

Are you a former member of NSAC?

Yes

Chapter Selection

Please select at least one chapter you would like to join from the list below: (you may join multiple chapters)

Chapter	States Covered	Dues
Electric Co-op	Nationwide	$25
Far Western	AZ, CA, HI, NV, UT	$20
Great Lakes	MI, WI, IL (Northern)	$10
Mid-West	CO, KS, NE, NM, OK	$10
Mississippi Valley	AR, IA, IL, IN, KY, MO, MS, OH	$10
North Central	MN, ND, SD	$10
Pacific Northwest	AK, ID, MT, OR, WA, WY	$20
Atlantic	DE, DC, MD, PA, PR, VA, WV, CT, ME, MA, NH, NJ, NY, RI, VT, AL, FL, GA, NC, SC, TN	$30
Texas	LA, TX	$10

Coop/Firm Information

Job Title

Coop/Firm Name:

Mailing Address (Please no PO Boxes)

City

State

Zip/Postal Code

Country

Work Phone (Include extension)

Fax

Toll-Free

Email Address

Website URL

CEO or General Contractor's Name

Where are your firm's customers?

CO-OP Type If your firm is not a cooperative, please choose "Not a Cooperative".

If "Not Listed", please describe

Professional Information

Are you a CPA?

Yes

Occupation

If other, please specify

Number of years in a cooperative activity or providing professional support to a cooperative activity:

Comments

Billing Contact Information Same as above

Contact Name

Cooperative/Firm Name

Mailing Address (Please no PO Boxes)

City

State

Zip/Postal Code

Country

Email Address

Phone (Please include extension)

Payment Information

Total to Charge

Promotional Code

Payment Method:

Visa

Master Card

American Express

Card Number

CVV2 Code (3 or 4 digits on back of card)

Credit Card Expiration Date

Name on Card

Approval of this application is subject to final endorsement by the Executive Board.
If you prefer to mail in an application with a check or money order, click here to download and print the membership application.