Conference Highlights

Donate_Module1

Subscribe_to_Newsletter Become_A_Member

Upcoming Events

ICAD AGM and Workshop
October 29 and 30, 2010
Lord Elgin Hotel
Ottawa, Ontario


 

Logo_AIDS2010
XVII International
AIDS Conference
Vienna, Austria
July 18-23, 2010

Quick Search




ICAD Membership Application Form – 2010

(PDF File)

Please complete the details below and return to ICAD with your annual membership fee. Membership will be effective from the date of the approval of the application by the ICAD Board of Directors.  Cheques should be made payable to ICAD. Membership runs on a calendar year (from January to December of each year).

The primary contact should be the person who would normally represent the organization at ICAD’s AGM and would reply to questionnaires and other inquiries. Written correspondence will be sent to the primacy contact however you may specify additional institutional contacts who will receive emails from ICAD.  Please provide us with a personal email address rather than a general “info” address if at all possible.


** mandatory

Contact Information

Primary Contact Person: **
Title
Organization Name (English)
If your Member/Organization Name does not have a version in english, please enter the french equivalent.
Organization Name (French)
If your Member/Organization Name does not have a version in french, please enter the english equivalent.
Acronym (english)
Acronym (french)
Address **
City **
Country ** Canada Outside Canada
Province ** Canada - Select Province:

Other
Type N/A if the Country is NOT Canada AND there is no international province.
Postal Code **
E-mail Address **
Website URL i.e. http://www.yourcompany.com
Telephone **
Telephone Ext
FAX
Additional Contact(s) (if any)
Telephone
E-mail Address

New memberships

Organizations applying to ICAD for membership for the first time are required to provide name and contact information from two members in good standing with ICAD willing to support your application to ICAD. Letters of reference are not required.

Reference 1
Name
Organization Name (if applicable)
Email

Reference 2
Name
Organization Name (if applicable)
Email

Mission Statement

Please write a short description (50 words) of your organizations activities and/or mission statement.

Description (english)

  

Description (french)

  

Privacy Disclaimer

ICAD will not use, disclose or retain personal information other than for the purposes for which it was collected, except with your consent, or as permitted or required by law. Please indicate whether you wish to have organizational or personal information posted on the web-site:




Membership Type

Please indicate the type of membership you wish to apply for: **

INSTITUTIONAL MEMBER

Open to any not-for-profit organization, association or institution (incorporated or unincorporated) which supports the goals and objectives of the Coalition. Full membership rights and privileges shall be accorded to Insitutional Members in good standing. Institutional Members have voting privileges at the Annual General Meeting and Coalition meetings, may stand for election to serve on the Board of Directors and any ICAD working group.
*Institutional Member fee is based on the organization's annual HIV/AIDS Program budget.

Budget of $3 million or more (enclose $400)
Budget of $1 to $3 million (enclose $250)
Budget of $100,000 to $1 million (enclose $150)
Budget of less than $100,000 (enclose $40)

Please indicate the type of organization:(check multiple if applicable):



Other, Please specify:

INDIVIDUAL MEMBER

Any person who supports the goals and objectives of the Coalition may be an Individual Member. Individual Members have the same rights and privileges as Institutional Members, detailed above.

Individual Member (enclose $40)
Student (enclose $20)
* Please provide a copy of your student card in order for your application to be processed.

The fee for individual PLWHA members will be waived



ASSOCIATE MEMBER

Any organization, association, institution or individual who supports the goals and objectives of the Coalition, but who cannot or does not wish to join as an Institutional Member or Individual Member may be an Associate Member. Associate Members can participate in the Coalition activities, including Committees struck by the Board with the exception of the Executive Committee. Associate Members cannot nominate Members to the Board of Directors, stand for office or vote.


Associate Member Organization:
Associate Member Organization fee is based on the organization's annual HIV/AIDS Program budget.
Budget of $3 million or more (enclose $400)
Budget of $1 to $3 million (enclose $250)
Budget of $100,000 to $1 million (enclose $150)
Budget of less than $100,000 (enclose $40)

Please indicate the type of organization:(check multiple if applicable):



Other, Please specify:
Associate Member Individual (enclose $40)

Additional Contribution

All members who wish to make an additional financial contribution to the operation of the Coalition are encouraged to do so.

Additional contribution $ (i.e. 50.00)

Please enter the characters above: