MATCH COALITION APPLICATION FORM

Thank you and congratulations on electing to be part of the Maternal Applications of Technology in Community Health (MATCH) Coalition. To be regarded as a member of MATCH, complete the following application. There is no cost to be a member; however, there are responsibilities and duties which Members shall uphold. Visit the MATCH Coalition Website (www.matchcoalition.us) for information about our coalition. Applicants may self-qualify by completing this online application form. Should you have any questions in the completion of this application, email info@macthcoalition.us.

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* 1. Individual/Company/Organization Details

Company's (or Individual's) Name *

Website *

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code

Country *

Email Address *

Phone Number *

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* 2. Representative's Contact Details

Name

Title

Email Address

Phone Number

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* 3. Your Organization's Mission Statement (150 Word Limit)

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* 4. Company Logo

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MATCH COALITION POLICIES AND MEMBER RIGHTS

1.0 Membership Rights and Obligations

Compliance with Policies. Member agrees to abide by, and shall have all applicable rights and obligations as set forth in these MATCH Coalition Policies, and any and all additional policies and procedures adopted, as any of these may be amended from time to time.

Member Voluntary Participation. Participation in the MATCH Coalition is voluntary. Members are to advocate for the general mission of the Match Coalition which is to promote the application of digital health technology where clinically appropriate for the purposes of improving maternal health.

Communications to Third Parties. From time to time, the MATCH Coalition will draft letters of support for legislative and regulatory activities that align to this mission. However, MATCH Coalition will seek the interest of each Member prior to issuing such correspondence and Members may elect to forego the inclusion of their name. Members are not obliged to endorse and/or sign on to communications to third parties (e.g., letters to legislative members in support of proposed bills or legislations).

Coalition Members agree to be supportive of the MATCH Coalition’s Goals and Objectives which are viewable on the MATCH Coalition Website (www.martchcoalition.us). Members also agree to be active participates in general meetings of the Coalition and when necessary may delegate a substitute representative.

Member Dues. Membership fees for 2021 are $0.

Logos and Names. You grant MATCH Coalition the right to use your organization's name and logo on the MATCH Coalition website and on related marketing materials, solely to indicate your membership in MATCH Coalition. As long as you remain a member in good standing, you may use MATCH’s name and logo, in the format and with the notices provided or requested by MATCH Coalition, solely to indicate your membership in MATCH Coalition.

Confidentiality. The Member shall limit disclosure of Confidential Information within its own organization to its directors, officers, partners, members, employees and/or independent contractors (collectively referred to as “affiliates”) having a need to know. The Recipient and affiliates will not disclose the confidential information obtained from the MATCH Coalition unless required to do so by law.

Suspension and Termination. The MATCH Coalition shall have the right to (i) suspend participation of Member if it fails to comply with its obligations, or (ii) suspend or cancel participation of Member if it violates any of the terms and conditions or engages in conduct seriously prejudicial to the purposes and interests of MATCH Coalition and fails to correct that breach within thirty (30) days of notice from MATCH Coalition.

2.0 General Terms

Authority to Execute Membership. The person agreeing to the terms of the MATCH Coalition Policies and Member Rights on behalf of Member hereby represents, warrants and covenants to MATCH Coalition that said person has the authority to enter into this membership and to perform its obligations herein.

No Other Licenses. By agreeing to these terms, Member neither grants nor receives, by implication, estoppel, or otherwise, any rights under any copyright, patents or other intellectual property rights of MATCH Coalition or another member, except as expressly provided in these terms and conditions (e.g., MATCH’s right to disclose and publicize the Member's membership in the Coalition, unless requested otherwise in writing by the Member).

Amendment. All amendments to these policies or to any MATCH Coalition terms and conditions shall be effective upon their stated effective date. Member shall be given at least thirty (30) days prior written notice of the effective date of an amendment to the policies. If Member does not agree to any such Amendment to these policies, then the Member shall discontinue its membership with the MATCH Coalition by emailing an notice of discontinuance to info@matchcoalition.us.

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* 5. Agreement to Terms and Conditions

AGREE - Yes, I/We understand and agree to the terms of the MATCH Coalition Membership

DISAGREE - No, I/We do not understand and/or do not agree to the terms of the MATCH Coalition Membership