KISWAHILI FRENCH

APPLICATION FOR MEMBERSHIP This application is only for residents of the United States of America and Canada. Please write to info@kivu-rise.org if you want information but live outside Northern America. Gender : Male | Female First Name : Middle Name : Last Name : Marital status : Single | Married * * If married : Spouse first name : Spouse last name : Street Address : Apartment : City : State : Zip Code : Home phone : Work phone : Extension : Cellular Phone : SMS (text) service Yes | No E-mail : Education : High School College University Specialty school Graduated : Yes | No Major : Profession : From Kivu ? Yes | No * * If yes, your local language is : * If no, how are you related to Kivu Born there Lived there Went to school there All of the above Traveled there Worked there Married to someone from there I am just a sympathizer Type your other connection to Kivu here. Do you speak Kiswahili ? Yes | No * Other languages : Type other languages that you speak fluently here. Additional Information : Please type additional information here. By checking this button I acknowledge that I have read the rules for membership at Kivu Rise and I am accepting them. I confirm that all information given above is correct. Kivu Rise info@kivu-rise.org