Membership Application

Welcome, and thank you for your interest in the Partnership for Quality Medical Donations (PQMD)! If you’ve arrived here while exploring membership, we’re glad you’re considering joining our global alliance of NGOs and corporations working to advance responsible medical donations and expand access to quality healthcare worldwide.

To begin the membership review process, our Membership Committee will need to learn more about your organization and your reasons for applying. Please complete the form below with as much detail as possible. Once submitted, a member of the PQMD team will reach out to discuss next steps.

If you’d like to learn more about PQMD membership or have questions before applying, please contact Jill A. Pall, Senior Director of Membership, at jpall@pqmd.org.

Name*

First NameLast Name

Organization*

Email Address*

example@example.com

Phone Number*

Please enter a valid phone number.

Website*

Mission Statement*

Vision Statement*

Top reasons for wanting to join PQMD*

What unique capability and perspective would your organization bring to PQMD? *

What year was your organization founded?*

Date

Do you have a board of directors?*

YesNo

If so please list your board names here.

Do you have approved by-laws?*

YesNo

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

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

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?*

YesNo

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

Please attach a copy of your annual report.*

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

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

Staff Structure*

Geographic Areas of Work*

Scope and focus of work*

Services or specialties*

Program Descriptions*

Describe the extent of your involvement in medical donations to include: Donations structure (e.g., percentage of donations that are medically-focused and if you currently operate a medical-products gift-in-kind (GIK) program) *

Activities in the areas of public health and global health policy (e.g, engagement with the World Health Organization (WHO), World Economic Forum (WEF), IFPMA Pharma and other important public health stakeholders)*

How did you learn about PQMD?*

Is there anything else you would like us to consider?

Membership Application

General Information

Organizational Information