Verification of Proposed Partner Form - The Mainstay Foundation

Name of Partner Organisation*

Name

Working name (if applicable)

Principal address*

Street Address City ZIP / Postal Code Country

Website

Main Contact

Name*

Prefix First Last

Contact number*

Email*

Enter Email Confirm Email

Position Within Organisation*

Are you employed on a permenant basis?*

If not, please enter your employment end date*

Contact information*

Please provide information for three of your Trustee board members. Add rows where necessary

Name	Address

Contact information*

Please provide information for your senior management staff. Add rows where necessary

Name	Position