Membership Form

To submit your membership application, fill out this form:

Name of the Organization / Institution or Individual Applicant (*)

Headquarters & year established (for institutions)

Headquarters (include city and country)

Year of establishment

Contact details

Address (*)

Telephone (*)

E-mail (*)

Organisational / institutional objectives (for institutions)

Individual applicants, please state why you wish to join

Current projects / programmes (indicate target group, implementation area; for institutions)

Names and positions of persons who will represent the organisation in the Alliance for Health (for institutions)

Do you agree with the Alliance for Health approach (*)

Yes

Authorisation to use your organization / institution’s logo on Alliance for Health internet and social networking platforms (for institutions) (*)

Yes

Upon consultation

Please confirm you have received and/or read Alliance for Health strategic documents (programme documents and membership criteria) (*)

Yes

I have read and accept the data protection policy *

(*) Required fields

DOCUMENTS TO BE ATTACHED TO THIS MEMBERSHIP FORM

The following documents should be e-mailed to: info@aliancaparasaude.org.

Membership will be effective following receipt of these documents and approval of the membership application. The decision on your membership application will be communicated once agreed with current Alliance for Health members.

Organisations/institutions:

Document proving legal constitution, either in Mozambique or country of origin. Organizations which are not legally constituted are not prohibited from participating provided they can provide the documents indicated below.
Digital copy of the Articles of Association/Statutes.
Annual Activity Reports for the last two (2) years.
Alliance for Health Statement of Principles signed by the organisation’s legal representatives (request this by e-mail from: info@aliancaparasaude.org).
Letter of presentation about the organisation and its work (digital copy accepted), indicating the organisation’s intention to participate in the Alliance for Health.

Individual applications:

Identity document (ID card, passport, other document).
Letter of introduction, including reasons for wanting to be a member of the Alliance for Health.
Alliance for Health Statement of Principles signed by the candidate (request this by e-mail: info@aliancaparasaude.org).