National Nonprofit Member Initial Application

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Constance Kelly
5 years ago
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1 To view the full set of application questions, download a PDF copy of this form. Non-governmental, not-for-profit organizations of national scope that are based in the United States and are supportive of the mission of the USBC may apply for and maintain national nonprofit membership, excepting such organizations whose primary purpose is to market or sell products or services in support of infant formula feeding. National nonprofit members are voting members of the USBC. To apply for national nonprofit membership, please fill out and submit this online application and then send the following by to office@usbreastfeeding.org: A cover letter written on organizational letterhead and signed by the CEO or an officer of the organization's Board of Directors If the organization's IRS Form 990 is NOT posted on GuideStar.org, a copy of the organization's IRS determination letter (to demonstrate tax-exempt status) If a web link is not available, a list of members of the organization's Board of Directors (see question 9 below) Any additional attachments needed for clear documentation of national scope (see question 11 below) If web links are not available, sample promotional materials about the organization (see question 14 below) Application fee (non-refundable, send with payment form) * 1. Organization * 2. Organization Contact Information Headquarters Address: : Website: : * 3. Contact Person (with questions about this application) : : :

2 * 4. What is the legal name of the organization holding the IRS tax exempt status? * 5. Please type or paste the organization's mission statement here: * 6. When was this organization formed? * 7. Please provide a brief summary of the organization's history. * 8. How is this organization currently funded? * 9. Please paste a web link to a list of members of the organization's board of directors. If this information is not available online, please send a file copy of the list to office@usbreastfeeding.org along with the other materials described in the introduction to this form. * 10. How many members does this organization have? (If not a membership-based organization, or the category doesn't apply, enter "n/a".) Individuals Organizations Other

3 * 11. Please describe how this organization conducts operations of a national scope. Examples of national scope include, but are not limited to, having membership in, or activities or services reaching, 4 of the 7 geographic regions of the United States (see USBC website for definition of Coalitions Regions). Include clear, supporting documentation. * 12. How has this organization protected, promoted, and supported breastfeeding in the last five years? Include brief descriptions of any current projects and links to any relevant publications about breastfeeding. 13. If the organization has not been active in breastfeeding in the last five years, what does the organization see as its role in protecting, promoting, and supporting breastfeeding in the future? * 14. Please paste a web link to sample promotional materials about the organization. If this information is not available online, please send file copies of the materials to office@usbreastfeeding.org along with the other materials described in the introduction to this form. * 15. Does this organization market or sell products or services in support of infant formula feeding? Yes No Please explain a yes response:

4 * 16. Member organizations are expected to send at least one representative to attend the general session portions of every membership meeting, and to participate in USBC activities according to their engagement levels on specific topic areas. Additional representatives are encouraged to attend as often as possible. Does this organization commit to sending at least one representative to USBC membership meetings? Yes No * 17. Each national nonprofit member shall name 1-4 individual representatives to the USBC. It is desirable that at least one representative hold a leadership position, and be authorized to represent the decision making power of the member organization, in order to serve as an effective conduit between the organization and the USBC. The recent policy change allowing up to four representatives expands member organizations capacity to connect with collaborative work on multiple specific topic areas. You may wish to ensure that you have a representative aligned to participate in each topic area identified as Core and/or Involved Engagement Level. Please designate this organization s representative(s) to the USBC: Representative 1 (This person is also your Poll Contact: the individual you wish to receive ballots and requests for survey response, etc.) Role/ in Organization 18. Representative 2 Role/ in Organization

5 19. Representative 3 Role/ in Organization 20. Representative 4 Role/ in Organization * 21. Member organizations are expected to report on organizational activities related to breastfeeding via the Group Profile in the USBC website. Does this organization commit to reviewing/updating its Group Profile in the USBC website at least once a year? Yes No 22. Group Profile Administrator access will be set up for the chief staff/ceo and all USBC representatives (designated above); if desired, designate an additional staff person to manage this here. To help us better direct information to you, please designate the following staff contacts. These individuals may or may not also be your representatives.

6 * 23. CEO or chief staff person * 24. Advocacy contact (the person you'd want to receive action opportunities re: legislation and policy, e.g., sign-on letters) * 25. Media contact (the person you'd want to receive media inquiries) 26. Social media contact (the person you'd want to receive social media opportunities, e.g., Twitter chats) * 27. Marketing contact (the person you'd want to receive information about opportunities for promotion at USBC events) * 28. Donation contact (the person you'd want to receive information about participation in the Friends of the USBC program)

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