CooperationWorks! Membership Application: INDIVIDUAL
This is the application for Individual Membership in CooperationWorks!

If you have any questions or difficulty filling out the application, please email membership@cooperationworks.coop

What is your name? *
Your answer
What is your email address? *
Your answer
What is your mailing address? *
Please indicate n/a if not applicable.
Your answer
Do you or does your most closely affiliated organization have a website you can share?
Your answer
What is your primary phone number? *
Please indicate n/a if not applicable.
Your answer
Individual Member Dues & Discount Eligibility
As an individual who engages in cooperative development, serves a co-op development center as a consultant, accountant or lawyer, or supports co-op development practitioners in any other way, your dues will be $350/year.

If you are an applicant who has participated in two or more weeklong CW professional development training sessions, you are offered a special $100 rate the first year of membership.
If eligible for the discount, please indicate the sessions you attended (e.g. Fall 2012, Session 1 & Spring 2012, Session 3).
Your answer
Member Details
In an effort to better orient our new members and connect them with a continuing member mentor, it is helpful to know a bit more about your current work.
Activities & Skillsets *
Please describe your current activities and goals, as they relate to membership in CW. Additionally, please describe your major ares or sectors of work (e.g. Worker Cooperatives) and unique skillsets (e.g. Start-Up).
Your answer
Membership Endorsement
Please provide one letter of endorsement from a current CooperationWorks! member in support of your proposed membership. If none are known to you, try reaching out to someone in your region. Current list of CooperationWorks! Members: www.cooperationworks.coop/about/members
Endorsement *
Please indicate by whom your endorsement letter will be provided.
Your answer
Member Engagement
CooperationWorks! carries out its work through a Circle (committee) structure. Members are asked to engage in CW through participation in at least one Circle. For more information:http://www.cooperationworks.coop/about/service-circles
Please indicate in which Circle(s) you would like to be a member. *
The Membership Contractor and Chair of the Circles you indicated will be in contact with you to get you involved as soon as possible.
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