Collective Membership Form Thank you for your interest in the Collective! Please answer the following questions to the best of your ability. If you have any questions, you can send an email to collective@tcf.org. Upon submission of this form, you can expect to hear back from our Membership Team within two to four weeks. Question Title * 1. Name (Last, First) Question Title * 2. Pronouns Question Title * 3. Organization or Professional Affiliation(s) Question Title * 4. Title Question Title * 5. State of Residence Question Title * 6. Email Question Title * 7. Phone Number Question Title * 8. Why do you want to join the Black Maternal Health Federal Policy Collective?(Response can include: written paragraph, video recording, or audio recording. Please attach the file type of your choosing. Keep written response to under 250 words and keep any video or audio recording under 2 minutes in length.) PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only. Choose File Choose File No file chosen Remove File Why do you want to join the Black Maternal Health Federal Policy Collective?(Response can include: written paragraph, video recording, or audio recording. Please attach the file type of your choosing. Keep written response to under 250 words and keep any video or audio recording under 2 minutes in length.) Question Title * 9. What experience do you have in policy or advocacy?(Examples can include but not limited to: current or prior professional roles, academic coursework, volunteer work, community organizing, student clubs/organizations, etc.) Question Title * 10. What does Reproductive Justice and Birth Justice mean to you? Question Title * 11. What skills would you bring to the Collective? Please select all that apply. Community organizing Grassroots advocacy Policy brief writing Bill writing Op-ed/commentary writing Public speaking Comms and press experience Social media experience Lobbying Policy evaluation Appropriations Bipartisan navigation Federal policymaking process Stakeholder engagement/liaison Federal agency relations Administration relations Clinician or health care provider Other (please specify) Question Title * 12. A requirement for Collective membership is participation in one of our working groups. Which working group most appeals to you? The descriptions for each working group can be found below:Policy Development and Accountability: Tasks include identifying and pursuing legislative opportunities, drafting legislation, providing rapid response to the Hill, reviewing policy proposals.Stakeholder Engagement: Tasks include organizing the Collective's participation at conferences, meetings, speaking opportunities and managing connections and relationship building.Communications and Outreach: Tasks include media engagement, content calendar, managing branded materials.Membership: Tasks include membership recruitment, onboarding, offboarding, and member accountability. Policy Development and Accountability Working Group Stakeholder Engagement Working Group Communications and Outreach Working Group Membership Working Group Question Title * 13. Are you willing and able to commit the requisite 3-6 hours per week (on average) to the Collective's work to advance Black maternal health policy? Yes No Question Title * 14. Much of the Collective's work takes place during business hours. Members must be able to spend work time on Collective activities. Do you have support from your organization or company to participate in the Collective? Yes No Question Title * 15. How did you hear about the Black Maternal Health Federal Policy Collective?(If you are being referred by a current Collective member, please list their name below.) Next