Membership Form – Collective Diaspora

Membership Application

TYPE OF MEMBERSHIP APPLYING FOR

By making a selection you are declaring that you, your cooperative or organization meets the criteria for that category

Black CooperativesJointly owned and democratically controlled enterprises whose membership and leadership are majority people of African descent as identified by the cooperatives themselves

Black-led organizations providing support to cooperativesOrganizations whose leadership (board of directors & executive staff – or full membership in the case of collectives) are majority people of African descent as identified by the organizations themselves

Affiliates

Affiliates are non-voting members able to benefit from the services of, and contribute to, Collective Diaspora. Affiliates consist of the following

Individuals of African descent who provide technical assistance to cooperatives or seek to support them in other capacitiesCollective Diaspora will support the growth and development of affiliates in service to the needs of Black cooperatives and Black-led cooperative support organizations.

Black Co-ops & Black-led Co-op Support Organizations

For Black Co-ops & Black-led Co-op Support Organizations

Preferred Language

Org. Details

Name

Acronym

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Tel.

Email Address

Website

Social MediaAdd social media accounts

Contact Person

Name *

Position *

Phone *

Email Address *

Description of organization *

Year Founded *

Industry/ECONOMIC ACTIVITY –

What sectors of the economy do you operate in or what sectors do you represent? (You can choose several options as necessary)

Agriculture, Forestry, Fishing, and HuntingAnimal CareArts & EntertainmentArtisan craft production

Build & DesignArchitecture & interior DesignEngineeringConstructionLandscaping

Community Land TrustEducation & ChildcareEnergy

ExchangesBarter Clubs / TimebanksMutual Aid Networks

Finance & InsuranceCredit Union / SACCORotating Savings & Credit AssociationInsurance CarrierFunds, Trusts, and other Financial Vehicles

Food ServicesRestaurants & CafesBakeriesCatering

Food Manufacturing

HealthHealth CentersHome Care Services

Housing

Manufacturing

MiningTourism & Hospitality

TradeWholesale TradeRetail Trade

Transportation & LogisticsDelivery ServicesTaxi ServicesRepair ServicesWarehousing

Water

WasteRecyclingCompostingReuseother waste management

Other services

Number of Members

Select here if members are organizations (not individuals)”.

COOPERATIVE TYPE

What type of a co-op are you?

(For secondary cooperatives and associations) What types of co-ops do you represent? (You can choose several options as necessary)"Producer/Marketing/Shared ServicesWorkerConsumer/UserMultistakeholderOtherPlease note: We determine “Cooperative Type” by the composition of the membership. Whether the cooperative is a legally formed entity or not is irrelevant in this case

What is your interest in joining Collective Diaspora?

REVENUENote: Cooperatives should only include sales from goods and services when calculating gross revenue and should not include income from donations (if any).

Affiliates

Name

Email Address

Phone

Website

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

In what ways do you currently support cooperatives

In what ways do you seek to support cooperatives

Organizational Affiliations and role(this is just for us to know who you currently collaborate with)

Individual contact information which you supply to us will be used to deliver our newsletters, announcements, invitations to events, and may be used to contact you for statistical information and networking within the cooperative movement. We will not sell your information. We will not share your personal information with anyone outside of Collective Diaspora structures and partners.

Please confirm your membership type *Black Co-op/Black-Led Co-op Support OrganizationAffiliate (Global South)Affiliate (Global North)