Join The Coalition by Jenny Macahon | Jun 23, 2020 "*" indicates required fields Step 1 of 6 16% What Type of Membership?*ORGANIZATIONS include Non-profit (NPO), Non-governmental (NGO), Unincorporated agency, and for-profit. COMMUNITY MEMBERS include Individuals and Academic Representatives. OTHER includes Governmental Agencies, Collaboratives, Foundations, Associations, and Survivor Consultants Organization Community Member Other Which best describes you?* Individual Academic Representative Which best describes you?* Governmental Agency Collaborative Foundation Association Survivor Consultant Your Name* First Last Institution* Organization Name* Employer Identification Number (EIN) Organization Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country How many representatives will you/your organization have?* 1 Representative 2 Representatives Representative 1's Name* First Last Representative 1's Title* Representative 1's Phone*Representative 1's Email* Committee Selection: Select one or more committees that Representative 1 will serve on for the year.* Education Committee Policy, Advocacy, & Research Committee Survivor Services Committee Economic Empowerment Subcommittee Steering Committee Please note: Similar to coalition meetings, representatives may share responsibility for attending a committee to meet the 50% committee meeting attendance requirements of Coalition Membership.Representative 2's Name* First Last Representative 2's Title* Representative 2's Phone*Representative 2's Email* Committee Selection: Select one or more committees that Representative 2 will serve on for the year.* Education Committee Policy, Advocacy, & Research Committee Survivor Services Committee Economic Empowerment Subcommittee Steering Committee Please note: Similar to coalition meetings, representatives may share responsibility for attending a committee to meet the 50% committee meeting attendance requirements of Coalition Membership. Join the UAHT Coalition I am interested in becoming a member of the UAHT Coalition.For more information about the UAHT Coalition, please email Misa Nguyen at coalition@uaht.orgJoin the Pathway I am aware that by joining the coalition I am also becoming a member of the Pathway, an online interactive database for survivors and case managers to access resources in one central location.As a member of the UAHT, you have access to join the Pathway. For more information about the Pathway, please visit www.uaht.org/the-pathwayInclusion in Coalition Memberships Directory I approve the listing of my organization and organization representative name & contact information in the Coalition Members Directory for distribution to coalition members.Website Posting I approve the listing of my organization's name and logo on the United Against Human Trafficking websitePlease Upload The Agency's LogoAccepted file types: jpg, png, Max. file size: 300 MB.Authorizing Electronic Signature* Total Payment Format Debit or Credit Card Check Please mail checks to United Against Human Trafficking P.O. Box 541184 Houston, TX 77254Credit CardCard Details Cardholder Name CAPTCHA Δ