New COSSBA Contact

IMPORTANT - This form should only be used when creating a first time user. If you or anyone else have created this user to attend a COSSBA event using this platform in the past then you will not need to create this user again. Once you go to register you will see the user on the contact list. If you or the user have forgotten your password please utilize the forgot password link instead of creating a second user.

General Contact Information

Contact Type *

Board Office

Affiliated State Association *

Occupation *

Prefix

First Name *

Middle Name

Last Name *

Suffix

Email *

Alternate Email

Business Phone

Mobile Phone

Home Phone

Affiliated School District (if applicable)

Contact Mailing Address Information

Street or P.O. Box *

Suite, Apt. or Office

City *

State *

ZIP/Postal Code *

Contact Event Attendance Information

Do you have any ADA Requirements?

Please let us know if you have any special needs. If you select yes, please email glenn.blind@cossba.org with your requirements.

Please indicate if you have any dietary restrictions. Please check all that apply. If none, please skip.

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