* 1. Full Name:

* 2. City:

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

* 4. Email address:

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

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

* 7. Permission:

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

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