Membership application form

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Institution Information

Institution Name^*

Type of Institution^*

Other(specify)^*

Institution Physical Address^*

Website URL:

Contact Information

Primary Contact Person

Name^*

Position/Title^*

Phone Number^*

Email^*

Membership Interests

1. What are your primary reasons for seeking membership in our cooperative? (Select all that apply)^*

Other^*

2. Please provide a brief description of your institution's mission, vision and activities^*

3. How do you envision your institution contributing to the cooperative?^*

4. What specific benefits or outcomes are you hoping to achieve through membership?^*

Additional Information

1. Are there any specific projects or initiatives you are currently working on that you believe would benefit from cooperative membership?^*

2. Please provide any additional comments or information that may support your expression of interest^*

Declaration^*

I hereby declare that the information provided in this form is accurate and complete to the best of my knowledge. I understand that submitting this form does not guarantee membership and that our institution may be contacted for further information or clarification.

Name & Signature^*

Position^*

Date^*

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Profile

Team

Major Services

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Profile

Team

Major Services

Other Support Services

Membership application form

Profile

Team

Major Services

Other Support Services