We are a national coalition of AIDS activists, many living with HIV/AIDS,working together to end the AIDS epidemic by advancing research on HIV/AIDS

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Membership Form


ATAC Membership Submission Form


ATAC is a U.S.-based coalition of AIDS treatment activists, persons living with HIV/AIDS, and their allies. Because of the nature of our work, direct employees of drug companies and indirect employees of a drug company, i.e., individuals engaged in rendering services to a drug company through a contracted, for-profit business, including without limitation public relations firms are not eligible for Full membership.

Please read and complete all requested information.

Contact Information
Desired User Name:
Password:
Confirm Password:
Full Name:
Phone Number:
E-mail:
 
Address 1:
Address 2:
City:
State:
Zip:
Country:
Personal History
Do you work (paid or volunteer) for any HIV related organization?

Yes

No

 
If you answered "Yes" above, then what is the name of the organization, and what is your title? (You can list more than one affiliation.)
 
Are you employed by the pharmaceutical industry either directly or as a contractor?

Yes

No

 
If you answered "Yes" above, please provide us with a description of your employment or contractual relationship:
 
Please write a short statement describing your personal interest in AIDS Activism and ATAC: (Just a few sentences, not more than a paragraph please.)
 
Do you have any special skills or areas of interest that you would like to share with ATAC?
Optional Information
 

The following information will be used to ensure that ATAC is reaching all communities affected by the epidemic in the U.S. This does not in any way affect your eligibility for membership, and you will not be penalized for refusing to answer.
 
What is your gender/sex?
What is your ethnicity/race?
 
Are you living with HIV?
(You are not required to disclose this information to be involved with ATAC)

Yes

No

 

ATAC now has one level of membership - Full.
Please read the following explanation.
 

- Full Member Full membership allows an individual full access to the current ATAC Discussion e-mail list - ATAC DISCUSS. Members may receive and post notices, participate in discussion about HIV-related issues, and receive updates from ATAC working groups and committees. All members of the DISCUSS list agree to abide by the confidentiality and courtesy standards set forth by ATAC in its Policies and Procedures. Full members must provide a completed application form (above) including relevant contact information. Full members who actively participate in an ATAC working group or sub-committee are considered "Full" members and are eligible to participate in organizational votes within their respective committees, as well as within ATAC as a whole. A Full member is expected to apply for and be accepted into one of ATAC's working groups or resources committees. A full description of the current working groups and resources committees can be found in ATAC's By-Laws and Policies and Procedures.
ATAC Groups
 
What Groups are you applying for?
(Please check all that apply)
Drug Development
BC4Basic (Educational Programs)
IBT/Vaccines
None at this time, I need to learn more about the opportunities
 

Everyone involved in ATAC must complete this membership request form.
 

The contact information you provided will be kept confidential . Please note: If you are applying for full membership, someone from ATAC may contact you in the near future to further inquire about your skills and interests.
 

Thank you for taking the time to provide the requested information. If you are accepted for "Associate" membership you will receive a welcome letter from ATAC and a list of e-mail/listserve guidelines in the near future.