Family name:
First name and middle name or initial:
Gender:         Age:        Citizenship:
Title or position:
Department:
Institution:
Postal Mailing Address:
E-mail Address:
Telephone: Fax: Telex:
Primary laguage(s):
Other spoken languages
(indicate fluent f, proficient p, basic b):
Other languages read:
Highest educational degree:
Discipline:
Current professional interests:
Experience:
Name of project, capacity, country:

Would you like to volunteer ot serve as an IFSA country representative
to collect association dues in local currency and forward them, in U.S.
dollars, to the treasurer if you can legally do this in your country of residence?
Yes/No :

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