Affirmed Member Name *

Legal Business Name *

Operating Business Name(s) *

CRA Business Number *

Business Address *

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Work Phone *

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Email Address *

Website Address *

Business Year Started *

Business Type? *

Do you carry E&O Insurance? If so, please provide the name of your provider *

Do you currently hold any Diplomas/Degrees/Designations? *

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Do you hold a Public Accounting Licence? *

Year Joined ATAP *

Date of Passing Qualifying Exam *

Year of latest signed Statement of Ethics *

Date of signed Statement of No Legal Action/Latest Police Record Check *

What is your highest level of Education (high school/college/university)? *

What are your Current CPD Credits (Jan - Dec of current year) earned? *

How many Staff (not including yourself) do you currently employ? *

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