Membership Application Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *Phone *What type of Membership best meets your needs?Full Membership: Please confirm that your organization meets the eligibility requirements, and that you have participated in CFE for at least 3 months.Ally Membership: Please confirm that your organization meets the eligibility requirements.Individual Membership: Please confirm that you meet the eligibility requirements for individual membership.I/we do not wish to be members of the Network.See membership guidelines for description- https://docs.google.com/document/d/16WLjCWaxvlhgf6eRl7svyH-XfotQxopWbDqBdGmfSG8/edit?usp=sharingWhat is the name of the person who will be your organization's primary contact? Multiple people are encouraged to participate but each organization must designate a Primary Contact. This is the person who will receive all official notices about voting, Membership Meetings, and other CFE Network businessFirstLastEmail address of CFE primary contact (if different)OrganizationMailing Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeHow should we list your organization on the CFE website, funding proposals, and other materials? For full and ally members, this is typically your organization name. For individual members, this would typically be your name, title and affiliation.If you or your organization does not want to be included on a list of Network members on the CFE website, funding proposals, and other materials, please explain here.Does your organization identify as a community-based or grassroots organization?YesNoDoes your organization identify as a BIPOC-led organization?YesNoWhat working group(s) are you interested in participating in (or having another member of your organization participate in)?Building PowerHealth/ScienceMarket ShiftPolicy/LegalNone of the aboveWhat projects, programs and initiatives are you interested in participating in?Childhood Cancer Prevention InitiativeClimate, Toxics, Health and EquityCommunications TeamEmerging Leaders CohortEquity TeamFundraising CommitteeHousehold Cleaners Health & Safety LabPesticides Coordination TeamOtherNone of the aboveI have reviewed CFE's Membership Guidelines and agree to all of the member commitments they contain *Yes, I agree to the member commitments.Submit
