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Your responses to the following questions will help us to develop a suitable partnership. You will be contacted by a VisionSpring representative within 48 hours of submitting this form.
1. Organization Name
2. Organization Website
3. Contact Information
Contact name, email & number
4. Mission/ Strategic Focus
What is the mission of your organization?
In which region do you operate?
Asia & Pacific
Latin America & Caribbean
Middle East & North Africa
6. Target Population
Who does your organization serve?
Those living on <$4 a day
Those living between $4 and $8 a day
Those living on >$8 a day
7. Delivery Financing
Do you sell your service or product, or provide it at no cost?
At full cost
At reduced cost
At no cost
8. Delivery Method (select any that apply)
Community Health Worker
Clinic or Hospital
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