Partnership Form

Section 1: About your Organization

Name of Organization

Type of Organization For-profit Non-profit University Non-academic research institute Other, please specify:

Address

City

Postcode

State/County (optional)

Country ---AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCentral African RepublicChadChileChinaColombiaComorosCongoCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDemocratic People's Republic of Korea (North Korea)Democratic Republic of the CongDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic Republic (Laos)LatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesia (Federated States of)MonacoMongoliaMontenegroMoroccoMozambiqueMyanmar (Burma)NamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRepublic of Korea (South Korea)Republic of MoldovaRomaniaRussian FederationRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth SudanSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyrian Arab RepublicTajikistanThailandTimor-LesteTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited Republic of TanzaniaUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamYemenZambiaZimbabwe

Website

Twitter

Section 2: Lead Contact Person

Title ---Prof.Dr.Mr.Ms.Mrs.MissSirDame

Name

Surname

Position

Email Address

Confirm Email Address

Phone (optional)

Mobile (optional)

Section 3: Administrative Contact

Tick this box if the lead contact person should also be contacted by EERN for administrative issues and proceed with Section 4

Title ---Prof.Dr.Mr.Ms.Mrs.MissSirDame

Name

Surname

Position

Email Address

Confirm Email Address

Phone (optional)

Mobile (optional)

Section 4: Partnership Details

Please choose your type of membership * ---Partnership (1,000 GBP/year)Acceleration Partnership (5,000 GBP/year)

Which regional chapter would you like to join? (tick maximum two) * North America Middle America & Caribbean South America Western Europe Africa Middle East Eastern Europe & Russia Central & South Asia East & Southeast Asia Oceania

What components/aspects of ecosystems are you most interested in? (tick all that apply) Policy / leadership / government Finance / investment Human capital / education Culture Support structures / infrastructure Markets / customers

How did you hear about EERN? (tick all that apply) Search engine Word of mouth Facebook Twitter LinkedIn My company / university Other, please specify:

Please upload your logo:

Please include current plans, initiatives, events, etc. or issues you want to work on with EERN in this section:

By clicking "Submit Form", you agree to the following privacy policy. Your institutional details will only be used to register you as a partner organization of EERN. The personal details of the named contact persons will only be used for EERN to contact you. We will not share your details with other third parties.

*Not all regional chapters have been established yet, but we will be very happy to get in contact with you to elaborate how you could get involved in this process and support us.