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Application for CCIH Membership
click here to download this application form
The mission of Christian Connections for International Health (CCIH) is to promote international health and wholeness from a Christian perspective.
CCIH provides field-oriented information resources and a forum for discussion, networking, and fellowship to the spectrum of Christian organizations and individuals working in international health.
I. Membership Categories (please select one)
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Individual Member |
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Individual membership is open to anyone who supports CCIH’s mission. |
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Organizational Member |
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Organizational membership is open to organizations which support CCIH’s mission and affirm a commitment to the Christian faith. |
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CCIH Affiliate |
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CCIH Affiliate status is open to organizations that promote health and wholeness globally, wish to support CCIH’s mission, and collaborate with CCIH and faith-based organizations, but do not organizationally affirm a commitment to the Christian faith. CCIH Affiliates are not officially members of CCIH but enjoy all the services and benefits of organizational membership except the right to vote at annual meetings and to serve on the Board of Directors. |
Note: For Organizational Members and CCIH Affiliates, this form is an application. The CCIH Board of Directors will review your application and inform you of its decision. Dues will be assessed on a sliding scale, according to an organization’s international health budget. For Individual Members, no Board action is required, only receipt of the application form and payment of the requested (tax deductible) contribution. The Board reserves the right to review applications for individual membership.
click here to download this application form
II. Contact Information
Date ____________________
Name and Title _____________________________________________________________
If applying for Organizational membership:
Organization ________________________________________________________
Executive Director/President/etc (include title) ___________________________
____________________________________________________________________
CCIH Contact Person (liaison) and Title (if different) _______________________
____________________________________________________________________
Address ____________________________________________________________________
City ________________________________ ST _____ ZIP __________ Country __________
Telephone: Work _______________________ _____ Home/Cell _____ ______________
Fax _______________________________
Email ___________________________________ Website ___________________________
III. Dues Owed: $_________
Please submit a check with your application form (made out to CCIH) or pay by credit card through Network for Good (US applicants only) by clicking here. Overseas applicants, please contact Sharon
Franzén at sfranzen@ccih.org for payment options.
ORGANIZATIONAL MEMBERS |
CCIH AFFILIATES |
International Health Budget |
Annual Dues |
International Health Budget |
Annual Dues |
below $100,000 |
$100 |
below $100,000 |
$100 |
$ 100,001 - 250,000 |
$150 |
$ 100,001 - 250,000 |
$250 |
$ 250,001 - 500,000 |
$200 |
$ 250,001 - 1,000,000 |
$500 |
$ 500,001 - 1,000,000 |
$250 |
$ 1,000,001 - 10,000,000 |
$1000 |
$ 1,000,001 - 5,000,000 |
$350 |
$ 10,000,001 - 50,000,000 |
$2500 |
$ 5,000,001 - 10,000,000 |
$500 |
over $50,000,000 |
$5000 |
over $10,000,000 |
$750 |
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Developing Country Org. |
$40 |
Developing Country Org. |
$40 |
INDIVIDUAL MEMBERS |
Regular Membership |
$50 |
Student, developing country resident, or low-income earner |
$25 |
Note: Membership is based on calendar year, and if dues are paid after October 1, applies to the next year.
Please fax, email, or mail this application form to Ray Martin at: 1817 Rupert St, McLean, VA, 22101, fax: 703-917-4251, email: CCIHdirector@aol.com.
CCIH Services and Benefits for Organizations
For Organizational Members and CCIH Affiliates:
- Monthly email bulletins containing information on new developments in faith-based international health, sources of funding, upcoming conferences, examples of promising practice, news about CCIH, and opportunities for public/private or secular/FBO partnerships
- Organization-strengthening and skills-building information and workshops
- Listing of your organization in our brochure
- Brief description of your organization on our website (www.ccih.org), and a link to your website
- Free access to advertising job openings or other opportunities on CCIH listservs
- Discounted registration fees at CCIH conferences and workshops
- Option of sponsoring an issue of The CCIH Forum or another CCIH publication that would recognize the sponsor and/or feature an issue of interest to the sponsor
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For Organizational Members:
- Facilitation in dialogue and partnership building in both the Christian and secular communities
- Opportunity to display and disseminate materials at our booth at conferences, e.g. Global Health Council, American Public Health Association, Global Missions Health Conference
- Voting rights at CCIH annual meetings
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For CCIH Affiliates:
- Guidance and support in assessing an organization’s policies and program activities relating to faith-based organizations
- Facilitation in bridge and partnership building with the faith-based community
Rev. Sept 2005 |
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