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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 Bell Mobility Bell Mobility Canada Boost Cellcom CellularOne CellularOne West Cellular South Centennial Wireless Cincinnati Bell Wireless Credo Mobile Cricket Edge Wireless Fido Canada 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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