AFRICAN FOUNDATION FOR PEACE AND LOVE INITIATIVES 12 Remoye Street, Akowonjo, Lagos State, Nigeria Tel. 01-792-8774, Email: applinig@yahoo.com, Website: http://www.africanprojectsforpeace.org KAIROS PEACE CLUB FIELD SERVICE/REPRESENTATIVE SIGN-UP FORM 1.        Description of Service: African Foundation for Peace and Love Initiatives wishes to offer members of her KAIROS Peace and Love Clubs (KPLC) the opportunity to continue to participate in the club by serving as field officers/representatives after their graduation from school. 2.        Nature of Field Representative The position of Field Representative is a volunteer. The Field Representative is expected to introduce and found any grassroots peace club promoted by AFPLI, any where, but preferably at their NYSC Service Station. For alternative field of service, please see Section 4 below. 3.        Member’s Information Name: ____________________________________________________________________________ Are you a member of KAIROS PEACE AND LOVE CLUB?                   Yes        0 No Membership Status: _______________________________________________________________ Institution: ________________________________________________________________________ What is the Name of your KPLC Current President? _____________________________________ What is the Name of your KPLC Current Staff Adviser? _________________________________ 4.        Probable Fields of Service Would you like to continue to participate in KAIROS after your graduation?  0 Yes        0 No Where would you like to service/participate?       (a) NYSC Station                 0 Yes        0 No                (b) Next School        0 Yes        0 No       ©   Community of Employment        0 Yes        0 No                (d) Anywhere        0 Yes        0 No 5.        National Service (NYSC) Information When is your NYSC Service Year likely to begin? _____________________________________ When is your NYSC Service Year likely to end? ______________________________________ What is the likely State of your NYSC Service? _______________________________________    What is the likely environment/occupation of your NYSC Posting? ______________________ 6.        Contact Information Can we contact you through your Parents? 0 Yes        0 No   Parent’s Address___________________________________________________________________ __________________________________________________ Cell Phone ______________________ Alternative Address ________________________________________________________________ __________________________________________________ Cell Phone ______________________ 7.        Expression of Willingness to Serve I, _________________________________________________, hereby freely pledge my consent to serve as a volunteer field representative of African Foundation for Peace and Love Initiatives during my NYSC Service Year.  I understand that this pledge is neither binding on me nor the organization. The organization is under no obligation to enforce this free contract against me. Signature ___________________ Date ___________________