Exhibitor Registration Form
South Carolina Tax Council
Post Office Box 887
Lancaster, South Carolina 29721
(Voice) 803-283-9988 (Fax)
803-286-8928
PLEASE COMPLETE, PRINT AND FAX TO 803-286-8928
Name:
Phone:
Firm:
Phone:
Address:
Fax:
City:
State:
Zip:
**************************************
Referred by the following SCTC member (not required):
Professional Designation EA PA
AP CPA Attorney
Other
Please provide License Number or EA Number:
Number of years experience as a professional tax preparer:
Age
Sex
Educational Background:
High School 2 Year College 4 Year College Masters PhD
Dates of Employment
Company
Position
******************************************
MORAL CHARACTER DATA (Please submit details on a separate sheet):
A.
Yes
No Have you been charged, arrested, indicted, or convicted, pled guilty of, or pled nolo contedere for violation of any federal, state, or local law (other than a minor traffic violation)?
B.
Yes
No Has any complaint been formally lodged or has any action been taken against your license in any jurisdiction?
C.
Yes
No Have you become a party to any civil suit, bankruptcy action, administrative proceeding, or binding arbitration; the basis of which is grounded upon an allegation of gross negligence, dishonesty, fraud, misrepresentation, or incompetence?
******************************************
Method of payment:
Credit Card
Check (mail to above)
Credit Card No:
Expiration Date:
I understand and agree that my credit card will be charged this amount.
I HEREBY CERTIFY, under penalties of perjury, that the statements above and information on this form are true and correct to the best of my knowledge and belief, that I have never been convicted of violating any federal, state, municipal or other law, statute or ordinance, other than disclosed as required above and that I have not suppressed any information which might have a bearing upon this renewal.
Signature _______________________________
******************************************
Please summit the above application with
Credit Card information for $80.00 to the South Carolina Tax Council for
the initiation fee of $20.00 and annual dues of $60.00 at fax 803-286-8928