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Intake form
Help us serve you better
Name
*
Email address
*
What is your age group?
Select
Under 18
18-24
25-34
35-44
45-54
55 and above
What is your current occupation?
Which area of the township do you reside in?
What programs are you interested in?
Please select at least one option.
Youth Fund Lobbying
Corporate Value Chain Links
Training & Mentorship
Media & Storytelling
How did you hear about us?
Please select at least one option.
Social Media
Word of Mouth
Community Event
Website
Are you interested in becoming a member?
Select
Yes
No
Maybe
What skills or expertise can you offer to the initiative?
Which service or services are you interested in?
Please select at least one option.
<strong>Township Development</strong>
Youth Empowerment
Research & Advocacy
Entrepreneurship support
Additional questions or comments
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