* Required

Full Namerequired

Street Addressrequired

Cityrequired

Staterequired

Zipcoderequired

Countryrequired

Cell Phonerequired

Occupationrequired

Employer (School District)required

Checkbox

I understand that the CCOSA PAC solicits personal contributions to provide financial assistance to potential candidates who support public education according to the CCOSA PAC Bylaws. CCOSA PAC contributions may only be made by active CCOSA members and do not impact CCOSA membership.

By clicking the submit button, I agree to terms & conditions.

Contribution Amount

Payment Options

I will be paying a charge of $ for months for an overall total of $ for years for an overall total of $ times for an overall total of $ times for an overall total of $ beginning with a charge today of $

Remaining payments will take place between and with the next payment occurring on

You can cancel your subscription by emailing cynda@ccosa.org or calling 405-524-1191

Please send a confirmation email to the address below*:

Please provide an email address where we can send a link to your current form.

Email Address :