Participating Institution Communication Form

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Participating Institution Contact Form
(Internet connection needed)

Dictionary of African Christian Biography
Overseas Ministries Study Center
490 Prospect Street
New Haven, CT 06511 USA
www.DACB.org

Please use this form to sign up as a new participating institution or to communicate news and updates to us. Before signing up as a new participating institution, please read our guidelines for participating institutions.

Institution Name   Required

Name of Responsible Officer

     Title

Liaison Coordinator Name   Required

     Title

Address Line 1

Address Line 2

Address Line 3

City

State or Province

Postal Code

Country

Telephone    Fax

E-mail

If you are writing to sign on as a new Participating Institution or Liaison Coordinator, please read our Guidelines for Participating Institutions and sign the following agreement:

"We hereby declare that we are willing to abide by the provisions and expectations governing participating institutions and liaison coordinators, as outlined in the Guidelines."

Signature: *

*Entering your name or initials in this space serves as your "electronic signature."

Write us a short message or update here (no more than 15 lines, please,
or the message will not reach us):