Family/Individual Application

**Press tab after each entry.

Date:
Name:
Address:
City:
State ZIP:
Home Phone:
Work Phone:
E-mail:
Occupation:
Church/Organization:
Language Spoken:
Special Interests/Hobbies:
Country/Region of Primary Interest:
Do you have children? number, sex and age:
Indicate interested institutions (see list on AMIS website):
Additional Information:

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