Name(s) _________________________________ Date: _______________________________
Address _______________________________________________________________________
City/ State ________________________ Phone (h) ________________________________
Zip ________________________________ Phone (w) ________________________________
E- Mail Address _______________________________________________________________
Connection to Niger (RPCV, etc.) ______________________________________________
Dates in Niger _____________________ Location in Niger ________________________
Program or Involvement in Niger _______________________________________________
_______________________________________________________________________________

Membership Dues & Contributions help fund FON Activities - including The Camel
Express, the FON website, Archives, and Projects such as Those Listed Below.

The Friends of Niger is a tax-exempt organization under section 501(c)(3) of the
Internal Revenue Code. Contributions to Friends of Niger are fully tax deductible.

                               Privacy Policy

Your contact information is requested and maintained by FON so that we can 
contact you in the future. FON will not share your contact information with any
third party unless you indicate on this form to that you would also like 
membership in the National Peace Corps Association (NPCA).

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Please Check Appropriate Boxes
[ ] Enclosed is $20 for an Individual Membership in FON
[ ] $55 to cover Individual Membership in both FON & NPCA
[ ] Enclosed is $35 for a Family Membership (2 Members at One Address)
[ ] I am a current Niger PCV, entitled to Free Membership
[ ] I am a New RPCV, entitled to a 1-Year Free Membership

[ ] In Addition to my Membership, I have enclosed
    a General Contribution of ........................................ ________

[ ] Instead of Joining FON at this time, I have enclosed
    a General Contribution of ........................................ ________

[ ] I want to support FON's Young Girls' Scholarship Program activities
    with a Contribution of ........................................... ________
    
[ ] I want to support FON's Microcredit in Niger activities
    with a Contribution of ........................................... ________
    
[ ] I want to support FON's Appropriate Technology activities
    with a Contribution of ........................................... ________

[ ] I want to support FON's Youth Education activities
    with a Contribution of ........................................... ________

[ ] I want to support the FON Chewable Vitamin Campaign
    with a Contribution of ........................................... ________

[ ] Please send _____ Friends of Niger T-Shirts
    at $15 each (Shipping Included) .................................. ________
    T-Shirt Sizes: S ____  M ____  L ____  XL ____
    Please Speicfy BROWN or BEIGE ...................._________________________

TOTAL AMOUNT ENCLOSED ................................................ ________

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Make Check or Money Order Payable to Friends of Niger and mail to:
 P. O. Box 5823, Washington, D. C. 20016-9998
Please complete and enclose this membership form.

FON Participation Menu
Indicate your interest with a check mark, or add something new in the space below.
[ ] Will help set up a local FON group
[ ] Would participate in a local FON group
[ ] Will be local FON contact person
[ ] Will be FON contact person for potential PCVs to Niger
Other: _________________________________________________________________________
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