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Register Interest for Membership

Please complete the form to apply for membership with Potentia.

First Name

Email

Last Name

Phone

Job Title

Company

How long have you been in your current role?

What industry does your business operate in?

What is the size of your business (in revenue)?

Are you a NED, Advisor or Trustee?

Enter LinkedIn Profile URL

How did you learn about Potentia?

What do you want to achieve through Potentia membership?

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