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First Name
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Last Name
Email
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Company Name
Company Role
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Number of Employees
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Company HQ Location
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Country Code
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Phone Number
I can confirm that the company I work for does not have significant interests in arms, tobacco or vaccine manufacturing
(Required)
Yes
No
My company is interested in:
Making a donation
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No
Enabling employees or customers to donate
Yes
No
Matching employees’ or customers’ donations
Yes
No
Driving employees engagement
Yes
No
My company has contributed to COVID-19 initiatives in the past
Yes
No
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Building brand awareness
Yes
No
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How many employees are in your company?
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The estimated amount we would like to contribute is
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