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* 1. First name

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* 2. Last name

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* 3. Email

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* 4. Social Enterprise

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* 5. Umbrella Organization

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* 6. Organization's mission

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* 7. Region

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* 8. Goods and/or services provided

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* 9. Select the Sustainable Development Goals (SDGs) you are working towards

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* 10. Is there anything else you would like to share?

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* 11. Please share the logo you would like to be included with your information (optional).

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