Application

CTEA –

Capital of Texas Enrolled Agents 

PO Box 6767 Round Rock, TX  78683 

IRS Approved CE Provider No. NX6M8 

State Board of Accountancy No. 07579  

Annual Membership Fee: $25.00  (Note: Members who are CPAs may be subject to an additional charge each February to help defray the annual TSBPA sponsor renewal fee.)   

Date_______________  

Name_____________________________________   

PTIN__________________________  

Designation (e.g., Enrolled Agent, CPA, Attorney, Return Preparer) ____________________  

Business Name_____________________________________________________________  

Email _____________________________________________________________________  Street Address______________________________________________________________  

City, State, Zip_________________________________________________________  

Business Phone__________________   FAX_________________ Cell_________________   

Are you willing to assist the group with presentations on your area(s) of expertise?  Yes/No Areas of expertise (e.g., Depreciation, Offers in Compromise, International Tax, etc.)   ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________