Trinidad and Tobago Non-Communicable Diseases Alliance
Membership Application
The Trinidad and Tobago NCD Alliance (TTNCDA) offers membership to civil society organizations in two (2) categories: Full and Associate
Please select the category that best fits your organization's objectives and purpose for joining the TTNCD Alliance.
Membership Type
Full Member
A Civil Society Organization (CSO) or Non-Governmental Organization (NGO) based in Trinidad and Tobago, whose mission is NCD focused. A full member participates in the governance of the Organization.
Associate Member
A Civil Society Organization (CSO) or Non-Governmental Organization (NGO), based in Trinidad and Tobago, with mission/objectives which complement those of the Alliance.
Which category of membership do you wish to apply for?
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Is your organization a member of any other alliance?
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Yes
No
Please list them:
Organization's Details
What is the name of your organization?
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What is your organization's physical/official address?
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Is the organization's mailing address the same as above?
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Yes
No
Organization's Mailing Address
Is your organization registered as a Non-Profit Organization (NPO)?
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Yes
No
Please provide the registration number
Is your organization registered or certified in any other way?
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Yes
No
Please state
Organization's Official Email Address
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example@example.com
Organization's Official Contact Telephone Number
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Organization's Official Website
Please provide the handles for your organization's social media.
Your Organization's Leadership
What is the title for the head of your organization?
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CEO
Chair
Director
President
Other
What is the name of the head of your organization?
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First Name
Last Name
What is the contact for the head of your organization?
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Your Organization’s Missions, Goals and Interests
Is your organization's mission focused on the prevention and control of any NCDs?
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Yes
No
Please select the NCD of focus (Select all that may apply)
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Cardiovascular Disease (e.g. Heart Attack/ Stroke)
Diabetes
Chronic Respiratory Diseases (e.g. Asthma/Lung Cancer)
Cancers
Other
Is your organization actively involved in addressing any of the common risk factors of NCDs?
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Yes
No
Please select any of the risk factors that your organization addresses (Select all that may apply)
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Tobacco Control
Harmful use of Alcohol
Unhealthy Diet
Inadequate Physical Activity
Obesity
Other
Please indicate the main goal(s) for your organization
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Promoting the needs of vulnerable groups e.g. Women and Children, People living with disabilities, People living with NCDs
Raising the priority of NCDs
Reducing risk factors and social determinants of NCDs
Contributing to the strengthening of national capacity to address NCDs
Strengthening and re-orientating health systems
Providing NCD and NCD-related Services
Promoting research and development and monitoring and evaluation
Other
Briefly list any key relevant achievements/activities undertaken by your organization within the past 4 years (can also be ongoing).
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What are your organzation's three (3) priority issues for capacity building?
Resource mobilization & Fundraising
Leadership & Management
Technical information
Social media management for NGOs
Marketing/communications/PR
Conflict of interest in NCD policy formulation
Project management/monitoring & evaluation
Proposal writing
In what areas can your organization provide support to the TTNCD Alliance:
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Technical Expertise (NCD/Health/Non-Health)
Volunteers
Communications/Public Relations
Training
Event Management
Networking
Social Media Management/Marketing
Planning Managing and Evaluating Advocacy Campaigns
Administration (HR, financial management, etc)
Other
Agreement and Signature
The organization agrees to pay the non-refundable application fee at the time of application.
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Yes
The organization agrees to pay the annual membership fee within 30 days of approval of the application.
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Yes
The organization declares that the information provided is true and correct.
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Yes
Signature [Please, sign your name in the box. You may use a cursor if on a pc, or an electronic pen or your finger, if on a mobile device]
Signed By (Name and Position)
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Date
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Month
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Day
Year
Date
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Apply for Membership
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