Tell Us About Yourself
First Name: Last Name:
Your Email: Phone:
Cell/Pager: Work Phone
Address: City:
State: Zip:
Affiliation:    
Yes! Count on me as a Harambee Ambassador
To be a leader in my business, industry, organization will be committed to raising a minimum of $3,500 Harambee Group
Yes! Count on me to be a part of a Harambee Circle
I will help organize a Circle that will raise a minimum of $3,500
Yes! Count on me to buy a Brick
I want to commerate my support for BFL by buying a brick engraved with the memory of a loved one, business name or favorite proverb.
   
Choose Your Brick Size (Call for engraving details)

Yes! Count on me for an ongoing membership:
I would like to join the BFL Membership Association and participate in special workshops, receive discounts on events and support agency programs

Yes! Count on me to make a one time donation to support BFL Programs $
Yes! Count on me to volunteer when needed I'm available:
I want to make a difference in the life of someone.
   
Comments:
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