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Application From
Organization Information
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1.
Organization Name:
(Required.)
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2.
Contact Person (Name and Position):
(Required.)
*
3.
Address:
(Required.)
Address
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Address 2
City/Town
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State/Province
ZIP/Postal Code
Country
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Email Address
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Phone Number
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4.
Contact Email Address:
(Required.)
5.
Website or social media page (if applicable):
*
6.
Is your organization community-based or community-led? Please describe:
(Required.)
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7.
Organization's Mission and Objectives:
(Required.)
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8.
Brief Description of Organization's Experience in Harm Reduction and Advocacy:
(Required.)
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9.
Are you applying as an initiative group using a fiscal agent?
(Required.)
Yes
No
10.
If yes, provide the name and details of the fiscal agent:
11.
Memorandum of Cooperation or Agreement (if applying through a fiscal agent)
Choose File
No file chosen
12.
Is your organization a member of any of the following networks? Please check all that apply:
Correlation-European Harm Reduction Network
Eurasian Harm Reduction Association
Drug Policy Network South East Europe
European Network of People Who Use Drugs