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1. Organisation Details

Tell us about your organisation and it's aims: Select the Cause that most closely represents the work of your organisation: Select the Pilar that most closely represents the activities of your organisation: Groups Structure: If Other please describe: The Geographical area you operate in: Electoral Area of your main base: Number of people involved in your organisation: Year Established: Facebook Page:
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2. Main Address For Correspondence

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3. Main Contact Details

Are you the Main Contact for this Organisation?

Will you be the representative or the alternative for your organisation in relation to the PPN?:
Continue to Step 4

4. Alternative Details

Alternate First Name: Alternate Surname: Alternate Mobile: Alternate Email:

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