International Member Application

Are you applying as an individual or organization?*

Individual

Organization

Your Name*

First Last

Pronouns

If other, please share:

Your Title/Position

Organization Name

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Telephone*

Alternative telephone

Email*

Website

Other contact/social media (Facebook, Twitter, etc.)

Please list any published materials on FGM/C that you have written in the past 5 years (if any), including but not limited to editorials, letters to the editor, articles, newsletters, and research. Please provide links where possible.

Values Alignment

By submitting this form, you are committing to support these values, and recognition that if you take actions or reflect views in the future that are not aligned with the Network’s values, you may lose eligibility to be a Network member.

The Network takes its values very seriously. Do you agree to fully support the Network’s values, as stated above?*

Yes

No

Are there any areas where you see possible conflicts between your values or work and the values of the Network?*

Yes

No

Maybe

If yes, please share more information about potential conflicts or concerns.

Membership Referral

How did you hear about The U.S. End FGM/C Network?*

If other, please share more.

Have you worked or partnered with any of our current members?*

Yes

No

Your response to this question will not effect your eligibility for membership.

If yes, please provide additional information include the member's name, contact information, and the context of your partnership.

Permissions

Do we have your permission to include your name on our website or other publications?*

Yes

No

Phone

This field is for validation purposes and should be left unchanged.

International Membership Information & Eligibility

About your experience and interest

Values Alignment

Membership Referral

Permissions