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FRIENDS OF THAILAND
11827 Orchard Road
Forestville, CA 95436

FRIEND OF THAILAND INFORMATION

Date __________________
Name(s) ____________________________________________________
Address ___________________________________________________
City __________________________
State _______________ Zip _____
Country (if applicable) _____________________________
Telephones: Home (_____)______________ Work (_____)______________
E-mail Address(es) _______________________________________________
Current Occupation ___________________________________________
PC Thailand Group Number (e.g. Thai 1) ________________________________________
PC Thailand Program ________________________________________
Dates of Service ______ to ______
PCV Site(s) _______________________________________________
Willing to serve as a Friends of Thailand Officer/member of Advisory Board
(check one) YES ___ NO ___
Permission to list name and e-mail address on the Friends of Thailand web site
(check one) YES ___ NO ___

FRIEND OF THAILAND MEMBERSHIP - DUES FOR 2002-2003
Enclosed is a check made out to FRIENDS OF THAILAND for (check one category)
___$00 newly returned PCV (one year following termination of service)
___$00 NPCA member with Friends of Thailand as an affiliate
___$15/individual Friends of Thailand Membership
___$22.50/family Friends of Thailand Membership
___$10 person in constrained financial circumstances
___ Other donation in the amount of $ ____

Please make checks payable to "Friends of Thailand" and mail with the completed INFORMATION AND MEMBERSHIP FORM to:
Friends of Thailand
11827 Orchard Road
Forestville, CA 95436