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COSCA Membership Application

Just fill out the online form below. When you’ve completed the form, hit the “Submit Form - Pay for Membership” button. This will email your form to us and take you to the payment page where you can pay your membership dues.

STEP 1: Complete Form

Clan, Society, or Individual Name*

Address*

Clans/Societies: please list the official mailing address for your organization

Address 2

City*

State / Province*

Zip / Postal Code*

Phone*

Clans/Societies: please enter your main contact phone number.

Email*

Clans/Societies: please enter the primary contact email address for your organization

Clan/Society Website Address

Clan/Society President: Name, Email & Phone Number

Clan/Society Treasurer: Name, Email & Phone Number

Estimated Number of Members

Are you or your clan/society on any of the following social media sites?
 Facebook Twitter MySpace Linkedin

If yes to any of the above, please give the appropriate user name or web address.

Additional Comments

STEP 2: Submit Payment

IMPORTANT: If you do not submit an online payment along with this online form, your membership will not be processed.


Name of Clan
Clan Website