Name and surname *

Position in the cooperative *

Name of the cooperative *

Kind of cooperative *

Country *

Email *

Web *

Phone *

Skype ID

Can your cooperative dedicate one person to the pilots for at least 4 hours a week? *
YESNO

Is that person fluent in English? *
YESNO

What challenge do you think we can help you with? *

How did you hear about the ECOOPE pilot experience?
Social MediaInternetUniversityFriends/AcquaintancesOther

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