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Only enter personal email and cell phone contact information.  NO CCSD email addresses.  Thank you.

First Name: *

Last Name: *

Address: *

City: * State/Province: * AB AK AL AR AS AZ BC CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MB MD ME MH MI MN MO MS MT NB NC ND NE NF NH NJ NM NS NT NU NV NY OH OK ON OR PA PE PR QC RI SC SD SK TN TX UT VA VI VT WA WI WV WY YT

Postal Code: * -

County: *

Country:

Phone:

Cell Phone: * Format (no spaces or dashes): xxxxxxxxxx Select Your Cell Phone Provider: -Select One- ACS Wireless AIO Wireless Alaska Digital Alltel Alltel MMS Ameritech AT&T AT&T MMS Bell Mobility Bell Mobility Canada Boost Cellcom CellularOne CellularOne West Cellular South Centennial Wireless Cincinnati Bell Wireless Consumer Cellular Credo Mobile Cricket Edge Wireless Fido Canada FirstNet At&T FirstNet (Verizon) Gmail Google Project Fi Inland Cellular Koodo Canada Metro PCS MobileOne MTA Telecom MTS Mobility Nex-Tech Nextel Ntelos Rogers/Tbaytel Mobility PCS Wireless Qualcomm Qwest Republic Wireless Sasktel Mobility Simple Mobile Spectrum Sprint MMS Sprint PCS StraightTalk Tbaytel Mobility/Rodgers Telus Mobility Thumb Cellular Ting T-Mobile T-Mobile Sidekick Total Wireless Tracfone Direct Union Wireless US Cellular Viaero Wireless Verizon Wireless Verizon Wireless MMS Virgin Mobile Virgin Mobile Canada Wind Mobile Xfinity Mobile * Send Me Text Message Alerts: YES NO

E-Mail Address: * Do not use the following email domains: WORK_EMAIL_ADDRESS@ccsd.edu Allow other members to view my email address

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School: *

CTA member (yes or no)?: *

CTAA (yes or no)?: *

CESA (yes or no)?: *

Member # :

Mailing Lists : (Check all that apply to you) - New Staff

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Password Strength: Weak Strong passwords contain 3 of the following items and at least 6 characters: - Uppercase Letters - Lowercase Letters - Numbers - Symbols

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