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* 1. What is your first name?

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* 2. What is your last name?

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* 3. When is your birthday?

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* 4. At what email address would you like to be contacted?

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* 5. Which of the following best describes you?

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* 6. What languages do you speak?

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* 7. I am interested in the following activities:

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* 8. I would like to be involved in the following Komité Ayiti Committee(s):

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* 9. What suggestions or ideas do you have for future events and activities of Komite Ayiti?

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