| Application for 2007 - 2008 Committee Service Return to: NYSSCPA Attn: Nereida Gomez, Sr. Committee Srvcs. Mgr., 3 Park Ave., New York, NY 10016 - 5991 or fax to Nereida Gomez, at 212-719-3364 An online application and additional information on the Society's committees may be found by visiting http://www.nysscpa.org and clicking on "Find Committees" on the left-hand side of the homepage. |
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| New York State Member Number: __________________________________________________________ | |
| First Choice: Committee Number: __________________________________________________________ | |
| Committee Name __________________________________________________________ | |
| Second Choice: Committee Number: __________________________________________________________ | |
| Committee Name __________________________________________________________ | |
| Serve on both committees: __Yes __No | |
| First Name __________________________________________________________ | |
| Last Name __________________________________________________________ | |
| Title __________________________________________________________ | |
| Firm __________________________________________________________ | |
| Firm Address __________________________________________________________ | |
| City ______________________________ | |
| State ______________________________ | |
| Zip ______________________________ | |
| Firm Phone No. ______________________________ | |
| Your Direct Phone No. ______________________________ | |
| Firm Fax No. ______________________________ | |
| Your Direct Fax No. ______________________________ | |
| E-mail Address * | __________________________________________________________ |
| Where would you like to receive your committee mail? __Business __Home | |
| Address __________________________________________________________ | |
| City ______________________________ | |
| State ______________________________ | |
| Zip ______________________________ | |
| If no business phone is available, may we print your home telephone number in the Leadership Directory? __Yes __No | |
| Experience | __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ |
| *
Providing an e-mail address is strongly encouraged as it is the most
effective method in providing timely communications to committee members.
If you need us to make special arrangements so you can serve on a committee, please do not hesitate to call the Sr. Manager, Committee Services, at 212-719-8358. |
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