Become a Member

This registration form is for not-for-profit dermatology patient organizations and groups who are interested in becoming members of GlobalSkin.

All fields marked with an * are mandatory and must be filled in prior to submitting the form.

Membership Application

Membership *

New Application

Total Amount

Member Organization Application

Tell us About Your Organization

Organization Name *

Please enter the name of your organization in your native language. If your organization has an acronym, please enter it at the end of your organization name. For example: World Health Organization (WHO)

Email for organization *

Describe your organization *

Include a 100-word maximum description about your organization.

Describe how you are currently supporting dermatology patients in your community. *

Examples can include programming, awareness events, advocacy efforts, etc.

Date Established *

Please select which World Health Organization Region your organization is in or represents. *

Africa

Americas

Eastern Mediterranean

Europe

South-East Asia

Western Pacific

International

Refer to the attached list for reference.

Country *

Street Address *

City *

State/Province (if applicable) *

ZIP or postal code *

Phone *

Select All Disease Areas

Select All

Check this box if your organization supports patients with all dermatological diseases. If not, please individually select the disease area(s) below.

Disease Area or Areas *

You can select one or more skin disease areas.

Approximately how many patients/members does your organization serve and support? *

Number of Paid Staff *

Number of Volunteers *

Please select which GlobalSkin Membership Type suits your organization. *

Full: Dermatology patient organization that is a registered not-for-profit entity.

Associate: Dermatology patient organization or group in the process of becoming a non-for-profit entity. Or, an online community that does not generate revenue from their work with patients.

Affiliate: Not-for-profit, non-patient led organization with dermatological focus, such as a research organization, or a dermatologist-led association supporting patients.

If you are applying for Full Membership, please attach a validation of your organization’s not-for-profit certification.

This can be the not-for-profit identifier number from your country, or you can send a file, such as a PDF, PNG, JPG photo of your certificate. If you cannot upload the document within the application, please e-mail it to: nicole.sudiacal@globalskin.org

Does your organization have a Governing Body (Board of Directors, Board of Trustees, Committee of Management, etc.) *

Yes No Other

If you’ve selected other, please explain:

Based on the following options please select the best description of your patient organization today. *

Starting up: At the beginning of our journey with a primary objective to help members/people with the disease(s)/condition(s).

Building: Making connections and tapping into resources for members/people in our group. Thinking about governance and ways to make our organization stronger.

Growing: Gaining momentum and engaging in several initiatives for members/people in our group. Hiring staff, working with volunteers, including strategic plans in our day-to-day work.

Maturing: Launching and sustaining programs with volunteers/staff/board in place to execute the mission and goals of our organization/group. Sustainable funding, active Governing Body with staff support to engage with other stakeholders to advance our mission.

Not sure

Organization Logo

Please attach an image of your organization's logo (acceptable file types are GIF, PNG, JPG, JPEG)

Please share the website and social media accounts used by your organization (must start with http:// or https://):

Website

Twitter

Facebook

Instagram

YouTube

Other

How did you hear about GlobalSkin? *

Twitter

Facebook

Instagram

YouTube

GlobalSkin Website

From another Patient Organization

Dermatologist

Other

If you’ve selected other for how you heard about us, please explain:

Organization Contact Details

Account

Please add a username to create an account. The username can be your email address. If you already have an account please login before completing this form.

Username *

Check Availability
Punctuation is not allowed in a Username with the exception of periods, hyphens and underscores.

Password

Confirm Password

Provide a password for the new account in both fields.

Primary Contact Details

First Name *

Last Name *

Position Title *

E-mail *

Phone *

Become a Member

Tell us About Your Organization

Organization Contact Details

Member Login

Sign in to your account