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Extended partnership application form

Name of organisation:

Name 1: Job title:

Name 2: Job title:

Address:

Telephone number:

Fax number:

E-mail address 1:

E-mail address 2:

Please explain the main role and responsibility of your organisation:

What can your organisation offer the ESPACE Project?

What does your organisation hope to gain from being a part of the Extended Partnership?

How did you hear about ESPACE?

Do you give consent for your contact details to be made available to the members of the Extended Partnership and the ESPACE Partnership?

If you are aware of any other organisation that would like to become an Extended Partner, please provide their contact details including an e-mail address:

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