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BMI Membership Intake Form
Thank you for your interest in joining the Black Midwest Initiative. We look forward to following up with you within 30 days of submission of your form.
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* Indicates required question
Email
*
Your email
First name
*
Your answer
Last name
*
Your answer
Current residence (City, State)
*
Your answer
Applicant type (check all that apply)
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Undergraduate student
Graduate or professional student
Postdoctoral scholar
College or university instructor or faculty member
Retired/emeritus faculty member
Independent scholar
Artist/creative
Organizer/activist
Community member
Other:
Required
Institutional affiliation (if applicable)
Your answer
Are you in agreement with the
mission, values, and vision
of the Black Midwest Initiative?
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Yes
No
What is your relationship to Black midwestern communities and why are you interested in joining the Black Midwest Initiative?
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Your answer
Are you interested in serving on any of the following committees? (check all that apply)
Note: Anyone who serves on a subcommittee will be invited to become part of the Council. The Council meets virtually three times a year and is responsible for overseeing and making decisions about the overall direction of the organization.
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Executive Committee: Meets at least once a month. Responsible for overseeing and making decisions about the day-to-day activities of the organization and for steering the implementation of decisions made by the Council.
Symposium Committee: Meets as needed. Responsible for planning and implementing the biennial symposium. (This committee is led by a steering committee that includes the lead organizers from the host city.)
Scholarship Committee: Meets as needed. Responsible for drafting the call, reading applications, and choosing the final recipients of the David C. Smith Memorial Scholarship.
Membership Committee: Meets as needed. Responsible for communicating with and recruiting individual and organizational BMI members.
Finance Committee: Meets as needed. Responsible for overseeing the financial health of the organization and developing opportunities for funding.
I am not interested in sitting on a committee at this time.
Required
Annual dues for membership in BMI range between $25-$75, depending on your membership type. Are you willing to pay dues in support of BMI? (We will follow-up later with information about how to process your dues payment.)
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Yes
No
How did you learn about the Black Midwest Initiative? (check all that apply)
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Institutional email
Social Media
Black Midwest Symposium
BMI member
Friend or colleague
BMI website
Other:
Required
Any questions or other information you would like to share? (optional)
Your answer
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