Pink Oak Members Registration Form
Membership of the Pink Oak Cancer Trust is open to not-for-profit non-governmental organizations in Nigeria. If you have read the membership criteria and duties of members and want your organization to register, kindly fill this form.
Email address *
Name of Organisation *
Your answer
Year Founded *
Your answer
Year of incorporation *
Your answer
CAC Registration Number
Your answer
Address of operational headquarters *
Your answer
Mailing address (if different from above)
Your answer
Contact email address(es) *
Your answer
Contact phone number(s) *
Your answer
Website address (e.g. http://pinkoak.org/) *
Your answer
Twitter (e.g. @pinkoaktrust) *
Your answer
Facebook page URL (e.g. https://facebook.com/pinkoak)
Your answer
Instagram handle (e.g. @pinkoaktrust)
Your answer
What is your organization's Vision Statement? *
Your answer
What is your organization's Mission Statement? *
Your answer
What are your organization's objectives? *
Your answer
List the names of your organization's founders/trustees *
Your answer
Name and title of the current Chief Executive Officer *
Your answer
Does your organization have a Governing Board or Board of Directors?
List key cancer awareness, advocacy, screening or treatment support programs/activities your organization has implemented, or is currently implementing *
Your answer
Does your organization raise money to support cancer patients? *
If "Yes", how many cancer patients have benefited from your organization's fundraising activities?
Your answer
What is your organization’s most remarkable achievement? *
Your answer
List other organizational partners your NGO has worked with in the past 5 years
Your answer
DECLARATION OF COMMITMENT: If accepted to become a member of The Pink Oak Cancer Trust, my organization hereby commits to (1) Sign the Membership Agreement, confirming that it agrees with the vision, values, mission, and goals of Pink Oak, and that it will perform all its duties and obligations as a member of the Pink Oak Members Forum. (2) Pay an annual dues in the amount agreed by the Members Forum, and approved by the Pink Oak Governing Board by the end of the first quarter of every fiscal year. *
Name, job title and phone number of the officer who completed this registration form on behalf of the intending member organization. *
Your answer
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service