Application Form – The G4 Alliance

contact@g4alliance.org

G4 Alliance Membership/Partnership Application

Thank you for your interest in joining the G4 Alliance. Before completing the application, here are a few things you should know.

The G4 Alliance is a coalition of organizations working to increase awareness, foster political will, shape policy, and mobilize resources to make access to quality, safe, timely, and affordable emergency and essential surgical, obstetric, trauma, and anaesthesia (SOTA) care a global health priority and a reality for all.
The G4 Alliance welcomes any organization that shares our commitment to building a just and equitable world. Our Code of Conduct outlines the core principles and expectations for corporations seeking to partner with us. By adhering to these principles, corporations can demonstrate their alignment with our mission and ensure their contributions support our work effectively and ethically.
We require two sponsors for any new member/partner. Sponsors can be any current member of the G4 Alliance, an organization, or a person. If you need assistance identifying an appropriate sponsor, don’t hesitate to contact us at admin@theg4alliance.org.
Prospective applicants should be ready to actively participate in collaborative discussions with the membership/partnership regarding these subjects. This involvement may include active participation in committees, working groups, and other forums to advance these discussions. It is essential to note that membership/partnership does not automatically imply collaboration with existing members, and any solicitation of such collaboration should neither occur nor be anticipated. Should organizations express an interest in forming partnerships with other members, such discussions are encouraged outside the designated time allocated for the G4 Alliance meetings and calls. Membership/partnership applications should not be motivated solely by a desire to pursue such collaborations during dedicated G4 Alliance interactions.
If you wish to apply, kindly provide comprehensive information about your organization and the motivations behind your application to the Membership Committee. Please ensure thorough completion of the application form below. After completion, click the submit button and a representative from the committee will promptly contact you to discuss subsequent procedures.

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Applicant Information

This information is required to enter you into our member database if your application is accepted.Email *

Name *

FirstLast

Preferred TitleYour Organization Your role in your organization Date of Birth (mm/dd/yyyy) *Phone Number *

Address *

Address Line 1CityState / Province / RegionPostal CodeCountry

Website *Mission Statement of Your OrganizationReason for wanting to join the G4 Alliance

What year was your organization founded? *

Do you have a board of directors? *

If so please list your board names here.

Do you have approved by-laws?

If so, please upload a copy of your approved by-laws

Click or drag a file to this area to upload.

If applicable, please attach a copy of your most recent 990 or equivalent for those outside the US

Click or drag a file to this area to upload.

If you are an NGO and do not have the above please explain why. *

Do you operate under detailed financial plans and budgets set by your governing board? *

Please attach a copy of your most recent audited financial statement. *

Click or drag a file to this area to upload.

Please attach a copy of your annual report.

Click or drag a file to this area to upload.

If applicable, please attach a copy of your Corporate Social Responsibility (CSR) brochure or documentation.

Click or drag a file to this area to upload.

If applicable, please attach a copy of your IRS registration letter or equivalent governmental recognition document.

Click or drag a file to this area to upload.

Staff Structure *Geographic Areas of Work *Scope and focus of work *Services or specialties *Program Descriptions *Activities in the areas of public health and global health policy (e.g., engagement with the World Health Organization (WHO) and other important public health stakeholders) *What unique capability and perspective would your organization bring to the G4 Alliance? *How did you learn about the G4 Alliance? *

What time of the day can we contact you?

Morning 9am to 11am
Afternoon 12 noon to 3pm
Evening 4pm to 6pm

Thank you for completing this application form. A copy will be emailed to you at the address provided.

Please note: If you fill out the form more than once, your new submission will replace your previous submission.

Email Claudio Tanca (claudio.tanca@theg4alliance.org) and Natalie Sheneman (natalie.sheneman@theg4alliance.org) for questions.

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G4 Alliance Membership/Partnership Application

Applicant Information

Thank you for completing this application form. A copy will be emailed to you at the address provided.

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