Membership Application

Membership Application
We are delighted that you’re interested in becoming a member of the Coalition for Independent Technology Research! To become a member, you must fill in this form, disclose any conflicts of interest, and agree to recuse yourself from any Coalition activities where/when your interests in the technology industry might represent a conflict of interest.

Conflicts of interest can include previously working for a tech company or receiving large grants from tech companies. At present, we do not accept people who currently work for a tech company. Our team reviews all member applications against our criteria for membership, including conflicts of interest and whether sufficient information can be found online to verify your work and alignment with the Coalition's mission.

The Coalition is a fiscally-sponsored project of Aspiration, and the data we collect is covered by the Aspiration privacy policy. The only information that we share publicly is your name and organization on the "Members" page of our website.

All questions are mandatory, but some are opt-out, and marked as so.
Name*

First NameLast Name
E-mail*
example@example.com
He/HimShe/HerThey/ThemPrefer not to sayOther
Which country are you currently based in?*
Which state, province, or county are you currently based in?*
This is so we can inform you about local events like member meet-ups
What is your organization or affiliation?
What is your current role or title?
IndividualOrganizational Representative
YesNo
JournalismCivil Society/AdvocacyAcademiaLegalOther
Please share any links to your current or recent work.*
YesNo
How did you learn about the Coalition?*
Why would you like to join the Coalition, and what do you hope to gain from being a member?*
EmailSignal HandleSignal NumberNone
Signal Handle or Signal Number
Please list any potential conflicts (COI) you or your organization may hold as follows:
1. Name of entity
2. Name of relationship
3. Date/year
These might include (a) current or previous funding from a technology company, (b) current or previous contract work with a technology company, (c) current NDA with a technology company.

Note that we do not view such conflicts of interest as disqualifying, but we do require their disclosure at the time of application and that any new COIs be declared as they arise.

We ask that you err on the side of caution in COI disclosure—listing any that might create real or potentially perceived conflicts.

Examples:
- Ollivander's Wand Shop. NDA covering conversations about Hogwarts security. 01/2019 - 10/2021
- Acme Corp. Financial Support. $50,000 undirected gift to support research and development on an Instant Tunnel. 06/2021 - present
Please list any potential conflicts (COI) you or your organization might hold.*
Please find our Code of Conduct here.
I confirm I have read and agree to abide by the Code of Conduct if my application is accepted.
Should be Empty: