Application Form: Individual Membership

Applicant’s Information

Full Name of Individual applying to be a recognized stakeholder of the HMHB Consortium:

First Last

Title

Email

Phone

Country

Expertise

Areas of Work and Interest

What type of organization do you work for?

Name of the Organization(s)/Institute(s) you work for:

What are you interests in advancing the use of MMS in low- and middle-income countries?

Scientific evidence
Advocacy
Policy development
Implementation
Implementation research
Manufacturing
Knowledge management
Corporate Social Responsibility
Other

Describe

Describe any specific activities you undertake or are planning to undertake to accelerate MMS use in LMICs.

Which particular skills, competencies, knowledge can you share with Consortium members

List the regions and/or countries where you primarily operate

Please provide any other information about your professional work that will help us assess your application.

Please upload relevant documents to support your application here.

Drop files here or

Accepted file types: pdf, doc, docx, odf, jpg, jpeg, png, Max. file size: 128 MB.

LinkedIn Profile

Website

Any other social media profile

I would like to subscribe to the HMHB e-mailing list and newsletter

Yes
No

If my membership is approved, I agree to have my name listed on the Member’s Page of the HMHB website. Tick this box if you do not agree to this.

I don't agree

Applicant’s Acknowledgements and Pledge to Support

Applicant agrees to:

Acknowledge the governance structure of the HMHB Consortium and comply with the HMHB Consortium’s:
- HMHB Membership Engagement Policy (and Principles of Stakeholder Engagement)
- HMHB Branding Guidelines
Contribute to the formation of the Consortium’s approved mission, strategic framework, and annual operational plans
Commit to applying their competencies and resources to work independently (or in collaboration with other partners/stakeholders) to accelerate the use of MMS in LMICs consistent with the strategic framework and annual operational plans of the Consortium
Share progress, knowledge, and accomplishments with the Consortium, and contribute to efforts to disseminate information through the contribution of stories, activities, and updates related to best practices, reports, projects, events, and news related to maternal nutrition and MMS.
Act according to its own organization’s Code of Conduct or in the absence of an organizational Code of Conduct work to abide by internationally accepted best practices in these areas.

Individual Applicant’s Statement of Agreement

By submitting this application, the applicant understands and agrees to HMHB's Membership Engagement Policy and Principles of Stakeholder Engagement and agrees to participate in the Consortium consistent with the points above.

Name

Title

Membership - Individual

Applicant’s Information

Areas of Work and Interest

Applicant’s Acknowledgements and Pledge to Support

Individual Applicant’s Statement of Agreement

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