Affiliate Application Form - MindFreedom International (MFI)

Your Personal Information

Your Name(Required)

First Last

Your Email Address

Enter Email Confirm Email

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Your Phone(Required)

Privacy(Required)

May we share your contact information with other organizations or activists?

Yes

Tell Us About Yourself(Required)

Briefly describe your personal background pertaining to mental health and/or human rights advocacy.

Affiliate Proposal

I agree to ensure that the activities of my proposed affiliate will align with MFI's core goals.(Required)

Our three core goals are (1) to oppose psychiatric human rights violations, including coercive treatment; (2) to support the self-determination of psychiatric survivors and consumers; and (3) to promote humane, effective mental health care. For more information, please see mindfreedom.org/about.

Yes

Proposed Affiliate Name(Required)

For example, "MindFreedom Australia," "MindFreedom Japan," "MindFreedom New York," etc.

Tell Us About Your Proposal(Required)

Briefly describe your initial ideas for activities, projects, and/or campaigns that your new affiliate might work on.

Any Questions For MFI?

Please feel free to ask us any questions that you may have. We'll get back to you as soon as we can.

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