Application Form - CanWaCH Associates

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Thank you for your interest in becoming an Associate of CanWaCH.

Associates are individual, non-voting participants in CanWaCH activities per the CanWaCH Membership Policy. Associates derive benefit through their involvement in CanWaCH and, in turn, add value to the organization through their participation. To become an Associate of CanWaCH, please complete the following form and follow the link to submit your payment. A CanWaCH staff member will follow up with you in the near future with details to submit your Associate fee payment. In the meantime, feel free to subscribe to our newsletter to stay up to date with current sector news and activities and to contact our staff if seeking to partner on a specific activity.

Please select all of the following criteria that apply to you: *

In my professional, academic, or volunteer activity, I conduct programming, policy development, research, or advocacy work either within Canada or abroad in the field of women’s and children’s health;

I am engaged in or support global health efforts related to women’s and children’s health, including sexual and reproductive health rights, adolescent health, and maternal, newborn and child health in low or middle income countries or humanitarian or fragile contexts;

I work according to principles of achieving gender equality, supporting gender equity, realizing human rights, and eliminating all forms of discrimination;

I am willing to provide and share programmatic information with CanWaCH to improve evidence-informed programming and amplify advocacy for women and children’s health within the sector; and

I will adhere to CanWaCH mission and bylaws.

Required

As a CanWaCH Associate, I agree to adhere to the following responsibilities: *

Commitment to collaboration and sharing of information for the benefit of other Members and Associates of the Partnership; and

Commitment to improving the lives of women and children.

Commitment to contribute an annual CanWaCH Associate fee of $100, as determined by the CanWaCH Board of Directors and ratified by Members

Required

Applicant Information

Full Name *

Website (LinkedIn, Twitter, other):

Full Address *

Email Address *

Brief Bio (900 characters max.):

Affiliated Organization/Institution and Title, if applicable:

The category that best represents you is [select all that apply]: *

Healthcare Professional

Graduate Student

Researcher

Academic

International NGO Employee

Volunteer

Board Member

Private Sector Employee

Government Employee

Other:

Required

I consent to receive communications from CanWaCH with relevant information *

Yes

Please share with us why you are interested in being an Associate of CanWaCH: *

Thank you and Next Steps

Thank you for completing this form. A member of the CanWaCH staff will be in touch soon to provide details on how to activate your Associate membership with your Associate fee payment.

If you have any questions about this form or your application please contact:

Nicole Jamrozinski
Senior Program Coordinator
njamrozinski@canwach.ca

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Canadian Network for Maternal, Newborn and Child Health. Report Abuse

Forms