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Welcome to the CAC2 Members Portal
The all-access portal to information for CAC2 Members.
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Please verify you are a non-profit with a primary interest in childhood cancer issues:
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To qualify for CAC2 membership as a Childhood Cancer Organization Member, an entity must be a nonprofit or coalition whose primary mission is focused on childhood cancer. If your non-profit or for-profit organization does not focus exclusively on childhood cancer, but you wish to support CAC2’s mission, we welcome your membership as a Supporting Organization. Please do not complete this application. Instead, please return to the Join page and complete the application for Supporting Organization Membership.
YES
Your Organization's Tax Exempt Number (EIN)
Begin the Membership Application Process
Your Organization's Name:
*
Annual Revenue:
*
Annual gross revenues from the organization’s most recent fiscal year (please consult Page 1 of your latest Form 990 or 990-PF). Please only list numbers here. If you need to make additional notes please use the Annual Revenue Notes later in this process.
Membership Dues Level (Based on Last Form 990 Annual Revenue):
*
CAC2 Organization Membership annual dues are determined by the annual gross revenues during your most recent fiscal year (please consult Page 1 of your latest Form 990 or 990-PF).
CHOOSE YOUR MEMBERSHIP LEVEL BASED ON REVENUE
Organization Member - $100K
Organization Member - $100K-$499K
Organization Member - $500K-$999K
Organization Member - $1M-$9.9M
Organization Member - $10M-$99.9M
Organization Member - $100M-$499.9M
Organization Member - Above $500M
About Your Organization
Organization Mailing Address:
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
IRS Designation:
*
501c3
501c3 - PENDING
501c3/501c4
501c3/509a1
LLC
No Designation
Does Not Apply
Voting Representative:
*
First
Last
Please designate the one person who will serve as the Voting Representative and main point of contact for your organization.
Voting Representative Email:
*
What is the best email to reach the Designated Voting Representative?
Voting Representative Cell Phone:
*
What is the best phone number to reach the Designated Voting Representative?
Member Organization Profile
We will use the information in this section to populate your organization's profile on the CAC2 website.
Organization Logo File:
Max. file size: 80 MB.
Please upload an image file.
Mission:
*
Describe your organization's mission.
Main Organization Phone:
*
How can the public reach your organization by phone?
Executive Director:
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Who leads your organization?
Organization Website:
*
If your organization doesn't have an online presence, please leave blank.
Geographic Footprint:
*
Local
Regional
National
International
Choose the geographical area most closely descriptive of the patient population your organization serves or the institutions your organization funds.
If you serve a region or a locality, please specify the geographical area.
Optional Focus Area Information: Please indicate the percentage(s) that best describes the focus your organization’s activities. Estimates are fine and should total to 100%
% Advocacy:
*
% Family Support:
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% Research Funding:
*
% Survivorship:
*
% Other:
Other Focus
If Applicable
Optional Organization Information
CAC2 tracks the impact our members have in a variety of ways. Please help us by completing the following questions about your organization's reach and impact.
Annual Revenue Notes
If Applicable
# of Families Impacted / Served:
# of Patients Impacted / Served:
# of Hospitals or Research Institutions Funded:
Number of Full Time Employees:
Number of Part-Time Employees:
Number of Volunteers:
Please provide an annual estimate.
Collaboration and Your Organization:
We like to celebrate and call attention to collaborative success. Please describe any collaborative effort(s) in which your organization participates in the pediatric cancer community – with other CAC2 members and/or outside of CAC2.
How did you learn about CAC2?
Invitation to Join
Internet Search
Twitter
Referral
Media
Facebook
Event
Other
Associate Members:
Organization Members can offer CAC2 membership to their staff and Board Members for no additional charge. Please designate associate members for your organization below, and CAC2 will add them under your account.
First Name
Last Name
Email
Your Contact Information
Are you the designated Voting Representative?
Yes
No
If yes, please skip the next three questions and choose a username and password. If no, please provide your name and contact information before choosing a username and password.
Name:
First
Last
Email:
Phone:
Choose A Username:
*
Enter A Password:
*
Enter Password
Confirm Password
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Billing Details
How do you want to pay for your membership?
*
Credit Card
Pay By Check
Billing Address:
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Credit Card
Card Details
Cardholder Name
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Merge Membership Level
Individual Membership
Student Membership
Organization Member - $100K
Organization Member - $100K-$499K
Organization Member - $500K-$999K
Organization Member - $1M-$9.9M
Organization Member – $10M-$99.9M
Organization Member – $100M-$499.9M
Organization Member – Above $500M
Supporting Organization - Less than $100K
Supporting Organization – $100K-$499K
Supporting Organization – $500K-$999K
Supporting Organization – $1M-$9.9M
Supporting Organization – $10M-$99.9M
Supporting Organization – $100M-$499.9M
Supporting Organization – Above $500M
Enquire now
Give us a call or fill in the form below and we will contact you. We endeavor to answer all inquiries within 24 hours on business days.
(222) 400-630
contact@ekko.com
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