EmailMe Form - ASPPA Credentialed Membership Reinstatement

Name *

Prefix First MI Last

Company: *

(provide company name, even if home address is noted below)

Company Owner’s Name(s)

Title: *

I am the owner

Address Type: *

Home Address

Business Address

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code

Work Phone *

### - ### - ####

Fax

### - ### - ####

Home Phone

### - ### - ####

Home ZIP Code (for government affairs purposes):

Work Email Address: *

Personal Email Address

For which credential(s) are you reinstating? *

I am an APA (Accredited Pension Administrator)

I am an ERPA

(IRS ERPA Enrollment No.)

I am an Attorney (Jurisdiction:)

I am a CPA (Jurisdiction: )

Which position best describes your job function? *

Which business most closely describes your place of employment? *

Please indicate the SEC or state insurance license you currently hold:

Series 6

Series 7

Series 65

State life or annuity insurance license:

State

License number

Code of Conduct:

Have you been found guilty of a felony, violation of insurance or securities regulations or any violation of the code of ethics of any professional or business
organization? *

Yes

No

If yes, please explain.

*

I have read the ASPPA Code of Professional Conduct and if my application is accepted I agree to abide thereby. I certify that the information provided in this application is true and correct to the best of my knowledge. The ASPPA Code of Conduct can be found online: https://www.asppa-net.org/footer/code-of-conduct/

Signature *

Clear

Date: *

MM / DD / YYYY

CE Verification:

I certify that my ARA Continuing Education (CE) Transcript contains the necessary credits to reinstate my inactive credential(s) (40 credits, including 2 ethics, earned within the 24-month period preceding the submission of this reinstatement application). It is my responsibility to self-report any non-ARA CE and verify all entries in my transcript are both accurate and meet ARA CE guidelines. (If you have any questions regarding your CE, call the ASPPA office at 703.516.9300)

Signature *

Clear

Date:

MM / DD / YYYY

Dues Payment:
Dues are paid on a calendar year cycle. Membership dues are prorated based on reinstatement date. *

Jan 1 - Jun 30: $750 (dues through 12/31)

Jul 1 - Oct 31: $375 (dues through 12/31)

Nov 1 - Dec 31: $750 (includes next year’s dues)

Retired or Government Employee (dues through 12/31): $100

Reinstatement Fee: *

$100 Reinstatement

I am paying by: *

Check

Credit Card

Credit Card Type:

Mastercard

Visa

Amex

Discover

Name as it appears on card

First Last

Credit Card Payment

Signature

Clear

Check Payments:
Paying by check? Please print a copy of your completed application and send with check payment to: ASPPA, P.O. Box 34725, Alexandria, VA, 22334-0725.

Questions? Please call us at 703-516-9300.

Tax Deductions:
Dues, contributions or gifts to ASPPA are not deductible as charitable contributions; they may be deductible, however, as ordinary and necessary business expenses. Federal law prohibits a tax deduction for the portion of membership dues attributable to lobbying expenses incurred by the organization. Consequently, for 2025, 18% of your dues are non-deductible in accordance with this provision.