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* 1. Full Name:

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* 2. City:

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* 3. Affiliation(s) with AFSC, date(s), location(s). This includes volunteer work. If none, please write none.

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* 4. Email address:

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* 5. If email is not the best way to contact you, please let us know the easiest way to reach you:

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* 6. Birthday greeting and/or reminiscence (150 words or less):

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* 7. Permission:

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* 8. I would like information about AFSC's current Africa programming.

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