IMPACT Membership Application

Membership Primer

Please read the IMPACT Membership Primer for full details on the values and expectations of membership.

Question Title

* 1. General Contact Information for Member Entity:

Entity Legal Name:

Entity is also known as:

Street Address of Entity:

Mailing address of Entity (if different from street address):

City/Town:

Province:

Postal Code:

Website for Entity:

General Email Address for Entity:

Phone Number for Entity:

Question Title

* 2. Primary Contact (Individual Applicant) for Member Entity: (if a Designated Alternate is listed, it is STILL the responsibility of the Primary Contact to share correspondence from IMPACT)

Name of Primary Contact:

Preferred Name & Preferred Pronouns for Primary Contact:

Title of Primary Contact:

Phone Number for Primary Contact:

Email of Primary Contact:

Name of Designated Alternate (must meet criteria of being the primary Member contact):

Preferred Name & Preferred Pronouns for Designated Alternate:

Title & Agency (if different from Applicant Entity) of Designated Alternate:

Phone Number for Designated Alternate:

Email Address for Designated Alternate:

Question Title

* 3. Does the primary contact person have decision making power for the entity?

Yes

No (*note: If no, a designate must be identified with the Backbone before membership can be confirmed)

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* 4. Is the applicant/entity interested in additional types of membership? (*Note: participating at any of these levels includes General Membership benefits - see below)

Yes - Working Group Membership

Yes - Mobilizing Membership

Yes - Mobilizing and Working Group Membership

I. General Membership:
General Membership is open to any Alberta focused entity, that intersects with reducing domestic/sexual violence.

□ By applying for membership, you are agreeing to your entity supporting IMPACT through:

Designating an Entity Representative for IMPACT;
Attending the general summit once every two - three years;
Subscribing to a shared vision, a common understanding of the issues and a joint approach to addressing the issues;
Sharing institutional knowledge and contributing to the collective’s goal of shared measurement (please note shared measurement is not necessarily data sharing, shared measurement is an agreement to collectively measure our impact as a collective);
Organizational representative will communicate within their organization, community, network about IMPACT;
Participating in community consults to inform and guide the work of IMPACT (every 3-5 years);
Participating in an annual survey.

□ Some of the opportunities available through General Membership are:

The right to vote;
Access to member-only information;
Free participation in webinars;
Reduced rate registration at Summits;

II. Working Group Membership is open to senior staff who (a) can speak for their organization, (b) are influencers in the working group’s area of focus and (c) can commit resources to the working group.

□ As a working group member of IMPACT, entities will commit to:

Working group member participating in 80% of meetings;
Allocating agency resources to support the working group member participating in IMPACT work;
Ability for working group member make decisions for IMPACT work;
Participating in shared measurement (outcomes, data, accountability).

III. Mobilizing Membership is open to entities whose senior leaders of their organization are influencers in DV/SV work in Alberta and can commit resources to the collective as a whole. Mobilizing members will sit on IMPACT’s Leadership Team.

□ As a Mobilizer of IMPACT, the member representative should meet the following criteria:

Decision maker for the entity with the ability to commit time and organizational resources to IMPACT initiatives;
Been in a leadership position for 5 years or more;
Attend 80% of meetings; (which will require travel – most meetings are 2-day quarterly meeting and take place in Calgary and/or Edmonton)
Be an ambassador for the vision/mission of the IMPACT;
Participate in the governance of IMPACT.
Have the support of the entity to be a mobilizer. (This requires a signed letter acknowledging and providing Mobilizer support by either a CEO, Board of Directors Chairperson or equivalent with the entity).