CooperationWorks! Membership Application: Organizational
This is the application for Institutional Membership in CooperationWorks!

If you have any questions or difficulty filling out the application, please email

What is the organization name? *
Your answer
Who will be the organization's contact person for membership? *
Your answer
What is the contact email address? *
Your answer
What is the organization's mailing address? *
Please indicate n/a if not applicable.
Your answer
What is the organization's primary phone number? *
Please indicate n/a if not applicable.
Your answer
Does your organization have a website it can share?
Your answer
Institutional Member Dues & Representative Status
Organizational Member Dues are as follows:
Operating Budget Dues
<$250k $1500
$250,001-$500k $2000
$500,001-$750k $2500
$750k-$1M $3000
>$1M $3000

Some institutions need to take on Representative Member status in lieu of Institutional status because they are a legal entity eligible to be an institutional member but prevented by law or policy from becoming a member or holding a membership in its own name. A Representative Member has the same dues rate as an Institutional member.

Will you need to take on Representative status? If so, please indicate why.
Your answer
What is your organization's operating budget?
Your answer
Member Details
In an effort to better orient our new members and connect them with a continuing member mentors, it is helpful to know a bit more about the current work you do within your organization.
Why do you want to be a member of CW? *
What do you anticipate getting out of CW membership?
Your answer
Purpose & Activities *
Please include your organization's mission or purpose, as well as the primary activities of the organization (e.g. small business development). Additionally, please describe your major ares or sectors of work (e.g. Worker Cooperatives) or specialties.
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:
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 of the following Circles: ADVOCACY, PROFESSIONAL DEVELOPMENT, MEMBERSHIP, NETWORKING. For more information:

As an institutional member, multiple staff people or members of your organization may also enjoy being a CooperationWorks! Member and, as such, will participate in conference calls, in-person meetings, Circle work, and receive all the information sent via the CW listserv.

Please list additional representatives, their email address, and in which Circle they would like to participate. *
The Membership Contractor and Chair of the Circles indicated will be in contact with you to get everyone involved as soon as possible.
Your answer
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.