Become a Member of AI Impact Alliance 
Membership Application 

Thank you for your interest in joining the AI Impact Alliance! Here's a little more information about how the application process works. 

The selection process for members is done on file and requires the approval of our board of directors. We invite you to complete the short questionnaire below, upon receipt our Selection Committee will study your request and we will contact you as soon as possible.

*Please note that at this time, we are only accepting applications from Civil Society Organizations (CSOs) as defined below. Only this category of members receive voting rights. 
  • Mission-oriented non-profit organizations and social entreprises whose principal mission is to promote human rights, sustainable development (SDGs) and Reconciliation with Indigenous and First Nations peoples.  
  • Civil society organizations including arts and cultural organizations, as well as community representatives. 
If you're not sure if you or your organization fit the criteria, apply and we'll get back to you shortly.
If finances are a factor preventing your organization from joining AI Impact Alliance, please contact us and we'll explore solutions. 

Once you receive a notification of acceptance, you will be required to pay 175$ (CAD). This helps us cover the minimal costs of getting the information you need on rapid changes in AI and its governance. You also access discounts for AI Impact Alliance's other services (see our website for more information). 

We will open to academic organizations at a later time. 

Industry and government are invited to sponsor our activities. Contact us for more information. 

Warm regards, 
Valentine Goddard
Founder and Executive Director
Sign in to Google to save your progress. Learn more
Email *
What is the name of your organization (or community you represent)? *This is the name that will appear as a member of AI Impact Alliance. *
What is your name, or the name of the contact person at your organization? Please indicate which one is a first name and family name and you preferred order. Ex: Tanaka (Family name) Atsushi (first name) or Valentine (first name) Goddard (family name). If you wish, please add preferred title if there is as well as pronouns.  *
What is the address of your organization? Please include the country and postal code. *
What is a phone number we can reach you at? This is only to be used in case we can't reach you by email. It will not be used for promotional purposes. Please let us know if you prefer us to use this method to contact you.  *
How many employees work there full time? *
Are you a registered organization, and if so, what type? *
If you answered Not-for-profit to the previous question, please describe your principal mission. Please include all relevant information such as charity status, mission declared upon registration, clientèle or community served, etc. Our Selection Committee might follow up. *
If you answered For-Profit above, please explain why you are a mission-first organization? For example, are BCorp recognized or in process of becoming so, are you a social entreprise (climate action, SDGs, Reconciliation and Indigenous economic development, regional social-economic development), cultural development, etc.)?  *
If you are not a registered organization but represent a community, please tell us more about the mission your community has vested in you and in what regard.
Do you foresee any potential conflict of interest? (funding sources, main mission, your members, etc) *
Thank you for your interest. We'll be in touch shortly!
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms