Membership Form Test 3 TYPE OF MEMBERSHIP APPLYING FORBy making a selection you are declaring that you, your cooperative or organization meets the criteria for that categoryBlack CooperativesJointly owned and democratically controlled enterprises whose membership and leadership are majority people of African descent as identified by the cooperatives themselvesBlack-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 themselvesAffiliatesAffiliates are non-voting members able to benefit from the services of, and contribute to, Collective Diaspora. Affiliates consist of the followinglabelIndividuals 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 OrganizationsFor Black Co-ops & Black-led Co-op Support OrganizationsPreferred LanguagePreferred LanguageEnglishSpanishPortugueseFrenchHaitian KreyolOtherOrg. DetailsNameAcronymStreet AddressApartment, suite, etcCityState/ProvinceZIP / Postal CodeCountry AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaAustraliaArubaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCabo VerdeCayman IslandsCentral African RepublicChadChileChina, People’s Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d’IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGuernseyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People’s Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People’s Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauNorth MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontserratMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSaint HelenaSaint Pierre & MiquelonSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUS Minor Outlying IslandsUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemen Arab Rep.Yemen DemocraticZambiaZimbabweTel.Email AddressWebsiteSocial MediaAdd social media accountsContact PersonNamePositionPhoneEmail AddressDescription of organizationYear FoundedIndustry/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 productionBuild & DesignArchitecture & interior DesignEngineeringConstructionLandscapingBusiness Support ServicesAccounting & BookkeepingLegal ServicesManagement, Scientific & Technical ConsultingGeneralMarketingSecurityTranslation & InterpretationCleaning ServicesPest ControlStaffing ServicesCommunity Land TrustEducation & ChildcareEnergyExchangesBarter Clubs / TimebanksMutual Aid NetworksFinance & InsuranceCredit Union / SACCORotating Savings & Credit AssociationInsurance CarrierFunds, Trusts, and other Financial VehiclesFood ServicesRestaurants & CafesBakeriesCateringFood ManufacturingHealthHealth CentersHome Care ServicesHousingManufacturingInformation & MediaBookstores & PublishersCopy & PrintingDigital ProductionGraphic DesignInformation Technology ServicesNewsSoftware PublishersTelecommunicationsMiningTourism & HospitalityTradeWholesale TradeRetail TradeTransportation & LogisticsDelivery ServicesTaxi ServicesRepair ServicesWarehousingWaterWasteRecyclingCompostingReuseother waste managementOther servicesNumber of MembersSelect here if members are organizations (not individuals)”.COOPERATIVE TYPEWhat 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 caseSCOPEInternationalNationalRegionalLocalSectoralCooperativeSecondary Cooperative (co-op of co-ops)Mutual Aid organizationcommunity development organizationwhat is your organizational structure? (Please choose only one option)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).AffiliatesPreferred LanguageEnglishSpanishPortugueseFrenchHaitian KreyolotherNameEmail AddressPhoneWebsiteStreet AddressApartment, suite, etcCityState/ProvinceZIP / Postal CodeCountry AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaAustraliaArubaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCabo VerdeCayman IslandsCentral African RepublicChadChileChina, People’s Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d’IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGuernseyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People’s Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People’s Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauNorth MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontserratMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSaint HelenaSaint Pierre & MiquelonSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUS Minor Outlying IslandsUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemen Arab Rep.Yemen DemocraticZambiaZimbabweIn what ways do you currently support cooperativesIn what ways do you seek to support cooperativesOrganizational 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. Terms and Conditions *Yes, I understand and accept the data protection policy of Collective Diaspora and consent to my information being used as per the policy.Send Message
