IRF National Alliance Corporate Member

IRF National Alliance Corporate Member
Completion of this form is a requirement for IRF National Alliance Corporate Member and must be completed by an active member of the organization.

If you have questions about this form or IRFNA, please email us at info@irfna.org.
Organization Name
Is your organization a registeredcharity/nonprofit or a support group?

Support Group (that is not a registered charity/non-profit)Registered Charity/Non-ProfitFor Profit Commercial OrganizationPharma/Biotech/HealthRelated
Please describe the mission of your organization. (This response will be displayed on our website's list of IRFNA Corporate Partners.)

0/400
Organization Contacts

Note, these are the two individuals that will receive the IRF National Alliance newsletter and be given seats in the IRF Corporate community on the National Alliance Portal. Given this, you may want to include staff members who check their emails regularly and/or have community facing roles.

Your Organization's Primary Contact
Name

First NameLast Name
Job Title
Email
example@example.com
Your Organization's Secondary Contact
Name

First NameLast Name
Job Title
Email
example@example.com
Organization Information
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Official Charity Number/Tax ID
Please check off the locations your organization serves:

LocalStateRegionalNationalGlobal
What year was yourorganization established?
Social Media Channels

Please input your company’s social media LINKS, not the handles, in the boxes below. For example, input https://www.instagram.com/corporatecompany/, not @corporatecompany. Please ensure any links entered begin with “https:www.”

This information will be featured on Immune Recovery Foundation’s website along with your organization name and logo. Providing this information will allow visitors to the Immune Recovery Foundation website to easily access information about your organization.
Website Link
Facebook Link
Twitter Link
Instagram Link
Your Organization's Patient Community
What diseases/disease areas does your organization support or represent?
Is your patient organization currently collecting health datafrom your patients (i.e., registry)?

YesNoUnsure
Areas of Work and Support
What are your organization’s main areas of community health focus? (Please select the top three.)

Disease EducationAdvocacy/Policy EducationMedical ReferralsMental Health Programs andServicesCommunity SupportFinancial SupportResearchOther
In which of the following can your organization best lend support to IRF National Alliance nonprofit members? (Please select 5.)

Development and/or ManagementGroup & Community SupportBoard Development Training and Capacity BuildingDiversity, Equity and InclusionResearch ReadinessFundraising/Grant WritingEvent Strategy & OrganizationStarting a non-profitDrug DevelopmentMental Health Content and ProgrammingAdvocacy - Government, Policy & LegislationGeographic/Logistical ExpansionSocial Media StrategyAwareness BuildingWorking with IndustryManaging Staff and Volunteers
Miscellaneous
How did you hear about the IRF National Alliance? Please select all that apply.

Referral from another NA MemberFormer Foundation Alliance MemberFacebook GroupImmune Recovery Foundation WebsiteEventEmailOther
As a IRF National Alliance member, you get access to a National Alliance community within the National Alliance Portal, where we share discount codes and networking opportunities for/at upcoming events. Would you like to join the portal?

YesNo
Note, this does not automatically log you into the IRFNA’s Portal. Once completed, you must still complete the steps to log in (i.e. setting a password).
Please upload your organization’s logo. This will be displayed on the IRF National Alliance Corporate website. Please ensure your upload is a small PNG or JPEG file.

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If you have questions about this form or the IRF National Alliance please email us at info@irfna.org

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