Local Chapter Forming Request Form

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Thank you for your interest to start or join a local chapter in your area. Please fill and submit this form and one of our staff will contact you soon.

In what way would you like to engage with Melese Duressa Institute? (Choose all that apply) *

Hold an event with Melese Duressa Institute

Have Melese Duressa institute participate on my event

Raise fund for Melese Duressa Institute

Volunteer for Melese Duressa Institute

Other

Have you engaged with Melese Duressa Institute previously?
*

Yes

If your answer is yes to above question, how did you engage with us? *

Donor

Volunteer/worked for Melese Duressa Institute

Attended events

I did not engaged with Melese Duressa Institute previously

Others

Enter your full name *

Enter your email *

Confirm your email *

Enter your phone number (include your country and local code) *

Confirm your phone number (include your country and local code) *

Enter your address or event address *

Enter event invite link or information *

Enter date of the event *

YYYY

Who will attend the event? *

Describe the event *

Do you like someone from our staff speak on the Event? *

Yes

If your answer to above question is yes, enter the name of our staff name you would like to speak on the event.

What do you expect from Melese Duressa Institute? *

Any additional request or message *

Submit

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