Membership Application Form

Thank you for your interest in becoming a member of IAPO!

Please check that your organization meets the criteria for Full, Associate or Network Membership before submitting a form. Applications for Affiliated Membership shall be done via their parent umbrella group or alliance via a specific form.

If you have any questions, please get in touch with us via membership@iapo.org.uk

Guide to application process and form

This form consists of four sections: PART A. Details of your Organization; PART B. Details of your IAPO Representatives; PART C. Type of Membership and Supporting Documents; and PART D. Declaration.

Please complete all sections in English, and upload all supporting documents in English.

1. IAPO will confirm receipt of your application and documents within two weeks.

2. We will review your application, and may ask for additional information and/or documents before sending it to IAPO’s Membership Committee, which assesses it according to IAPO’s Statutes and Bylaws.

3. The Committee can: i) approve the application subject to the payment of the membership fee (Full and Associate Members only), ii) request further information and documents, or iii) reject the application. At this stage, the Committee also assesses Fee Waiver requests (Full and Associate Members only). Please note that the approval of the membership application doesn’t automatically approve the Fee Waiver request.

4. If the application is approved, and membership fees are i) paid after we contact you and send an invoice or ii) waived (Full and Associate Membership only), you can start enjoying all the benefits of becoming an IAPO member.

If you have any queries regarding the membership process or supporting documents, please contact us via email on membership@iapo.org.uk.

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PART A. Details of your Organization

Organization name as it appears on your legal registration certificate or document	Organization name in English (if different to legally registered name)
Acronym if used e.g. IAPO	Disease area e.g. Ovarian Cancer, Diabetes, Cross-Disease
Year established	Area the organization works in please choose one e.g. LOCAL: London, NATIONAL: UK, REGIONAL: Europe, INTERNATIONAL
Organizational profile: Please let us know, in a maximum of 100 words, about the work of your organization. Please provide a brief summary of what your organization does, its primary focus and work areas, and who you represent.	Organizational annual income in USD

Is your organization an umbrella group of member organizations?	If yes, how many member organizations does your organization have?
Approximately how many individuals does your organization represent? e.g. patients, family, caregivers, supporters etc. (if applicable) e.g. 50000	Approximately how many patients does your organization represent overall? e.g. 50000

Building number or name AND street name	City, Province or State	Country
Post or ZIP code	Telephone number, with country code	General organization email address
Website	Youtube	Facebook
Linkedin	Twitter

PART B. Details of your IAPO Representatives

The IAPO Representatives should be the people we can liaise with when communicating with your organization. Whilst you may put your Chief Executive as the IAPO Representative, please consider carefully if he or she will have sufficient time to respond to our communications. You may alternatively wish to put down the name of a member of the governing body, or a senior manager involved in external affairs, policy, collaboration or another appropriate area.

In giving us their details, these people agree to:

• Receive annual renewal invoices.

• Respond to consultations where relevant for your organization.

• Represent your organization at IAPO’s General Assembly.

• Receive communications from IAPO.

IAPO Representative 1

First name	Surname
Position	Email address
Direct telephone, with country code	Please, mark the option that best applies: I'm a patient.I'm a carer.I am a patient and a carer.I am not a patient nor a carer.

IAPO Representative 2

First name	Surname
Position	Email address
Direct telephone, with country code	Please, mark the option that best applies: I'm a patient.I'm a carer.I am a patient and a carer.I am not a patient not a carer.

If anyone else in your organization would like to receive newsletters, please give their details below.

First name

Surname

Position

Email address

Please tick if you wish to have your website and email address included on our website

Please tick if you wish to have your website included on IAPO's website.

PART C. Membership Category and Supporting Documents

IAPO has four categories of Membership: Full, Associate, Network and Affiliated.

Please check below the criteria and correspondent supporting documents for Full, Associate and Network Membership, and tick below which category you are applying for.

Applications for Affiliated Membership shall be done via their parent umbrella group or alliance via a specific form.

If you have any questions, please get in touch with us via membership@iapo.org.uk.

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Membership Criteria

1. The organization must be non-profit and non-governmental.

2. The organization must have a legal status appropriate to the country of origin.

3. The organization may be an international, regional, national or local organization, or an umbrella group.

4. The organization must demonstrate commitment to patients and the principle of patient-centred healthcare.

5. [FULL MEMBERS ONLY] The organization must be patient-driven: the needs and views of patients drive the organization’s strategy, policies and activities in a significant way.

[1] We define a patient as “a person with any chronic disease, illness, syndrome, impairment or disability”. We aim to be representative of all patients regardless of gender, race, class, culture, religion or belief, age, sexuality, lifestyle or degree of able-bodiedness.

[1] We define patient representatives as “patients’ organization representatives, family members or carers”. Examples of patient representatives are a parent of someone with cystic fibrosis, or the spouse of someone with Alzheimer’s Disease.

Documents in English

Membership Category

Full

Associate

Affiliated

Network

1. Legal Registration Certificate. If no appropriate legal status exists in the country, this criterion may be waived at the discretion of the IAPO Governing Board.

Yes

Yes

Yes

Yes

2. Written evidence of commitment to patients and the principle of patient-centred healthcare. For example: a statement, letter, strategic plan, mission and vision, or Bylaws and constitution. Typically the organization’s mission will be to respond to the needs of patients in a specific geographical or disease area, supporting and representing them.

Yes

Yes

Yes

Yes

3. Most recent set of audited Accounts OR statement from their accountants OR, for organizations with an income of less than USD 100,000, IAPO’s Organizational Annual Income Statement Form.

Yes

Yes

N/A

N/A

4. A letter or statement which explains how the organization ensures that it is patient driven, and is capable of representing the needs and views of these patients. Full Members must demonstrate that they use at least one of the following methods:

o   The majority of the organization’s voting rights to nominate and elect the governing body of the organization are held by patients (1), patient representatives (2), or representatives of patients’ organizations.

o   The majority of the organization’s governing body are patients, patient representatives, or representatives of patients’ organizations.

o   The organization’s strategy, policies, and activities are driven by, and represent, patient’s needs and views. Patients and patient representatives may in addition support and drive the organization financially through voluntary contributions.

Yes

N/A

N/A

N/A

5. If the applicant is an umbrella organization, a full list of member organizations.

If applicable

If applicable

If applicable

If applicable

6. If the applicant wishes to have their fees waived for 1 year, a completed/filled in Fee Waiver Form.

If applicable

If applicable

N/A

N/A

Please choose the membership category you are applying for:

Full Membership Associate Membership Network Membership

Please note that you must provide supporting documentation specified below to be considered for membership.

Upload your legal registration document - Originals and English translation (if applicable). If no appropriate legal status exists this criteria may be waived at the discretion of IAPO’s Governing Board.

Upload your most recent set of audited accounts OR Statement from your accountants OR, for organizations with an income of less than USD 100,000, IAPO’s Organizational Annual Income Statement Form - Originals and English translation (if applicable).

Upload written evidence of commitment to patients and the principle of patient centred healthcare, for example a statement, letter, strategic plan, mission and vision, or By-laws and constitution - Originals and English translation (if applicable).

Upload a letter or statement which explains how the organization ensures that it is patient driven - Originals and English translation (if applicable).

If the organization is an umbrella organization, please upload a full list of members - Originals and English translation (if applicable).

Please choose the invoice option below (our Membership Fee structure can be seen here: https://www.iapo.org.uk/fees-and-payment):

1 Year3 YearsFee waiver

If you would like to request a Fee Waiver, please fill in and upload this form here.

Your name

Position

PART D. Declaration

By submitting this application you are agreeing to your organization’s details being kept on IAPO’s database. We will not share any information about your organization (apart from the publicly-available information on our website) with anyone else without your permission.

I confirm that I have the appropriate authorisation to submit this application on behalf of the named organization; and that to the best of my knowledge, the information on this application form, and within the supporting documentation, is accurate.

I also confirm that the named organization is committed to patients and the principle of patient-centred healthcare; and is eligible to be a Member, as defined.

Documents in English	Membership Category
Documents in English	Full	Associate	Affiliated	Network
1. Legal Registration Certificate. If no appropriate legal status exists in the country, this criterion may be waived at the discretion of the IAPO Governing Board.	Yes	Yes	Yes	Yes
2. Written evidence of commitment to patients and the principle of patient-centred healthcare. For example: a statement, letter, strategic plan, mission and vision, or Bylaws and constitution. Typically the organization’s mission will be to respond to the needs of patients in a specific geographical or disease area, supporting and representing them.	Yes	Yes	Yes	Yes
3. Most recent set of audited Accounts OR statement from their accountants OR, for organizations with an income of less than USD 100,000, IAPO’s Organizational Annual Income Statement Form.	Yes	Yes	N/A	N/A
4. A letter or statement which explains how the organization ensures that it is patient driven, and is capable of representing the needs and views of these patients. Full Members must demonstrate that they use at least one of the following methods: o The majority of the organization’s voting rights to nominate and elect the governing body of the organization are held by patients (1), patient representatives (2), or representatives of patients’ organizations. o The majority of the organization’s governing body are patients, patient representatives, or representatives of patients’ organizations. o The organization’s strategy, policies, and activities are driven by, and represent, patient’s needs and views. Patients and patient representatives may in addition support and drive the organization financially through voluntary contributions.	Yes	N/A	N/A	N/A
5. If the applicant is an umbrella organization, a full list of member organizations.	If applicable	If applicable	If applicable	If applicable
6. If the applicant wishes to have their fees waived for 1 year, a completed/filled in Fee Waiver Form.	If applicable	If applicable	N/A	N/A