Infinite Family Online Application Begin the process to become an Infinite Family Video Mentor! Salutation: First Name* Last Name* Prounouns Address* Street Address City State/Province/Region Postal / Zip Code Country:* Time Zone Abreviation:* Home Phone* Mobile:* Work phone: Preferred Phone:*Select valueHomeWorkMobile Fax: Personal E-mail:* Work E-mail: Preferred Email:*Select valuePersonalWork Verify your Preferred Email:* Date of Birth:*01020304050607080910111213141516171819202122232425262728293031day / JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecembermonth / 201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925year Marital Status: Country of Birth:* Gender:*ManWomanAgender/NeutroisAndrogyne/PangenderNonbinaryTransgender ManTransgender WomanPrefer Not to Specify Language Spoken (Select all that apply):*EnglishAfrikaansChineseFrenchGermanHindiIsiNdebeleIsiXhosaIsiZuluPortugueseRussianSipediSethosoSetswanaSiSwatiSpanishSwahiliTagalogTshivendaXitsongaOther Occupation Status (Choose all that apply): Full Time Part TimeStudentRetiredOther Work Business Name: Work Address: Street Address City State / Province / Region Postal / Zip Code Work Country: Where do you have computer access? (Choose all that apply):*WorkHome Where do you have high speed Internet? (Choose all that apply):*WorkHome Which software programs do you use most often at home and at work and what are your online activities?:* Which operating systems do you use at home? (Choose all that apply):*MicrosoftMacLinuxOther Which operating systems do you use at work? (Choose all that apply):*MicrosoftMacLinuxOther What OS will you be using to communicate with your Net Buddy mentee in Africa? (Choose all that apply):*MicrosoftMacLinuxOther How did you hear about Infinite Family?:* Check the boxSubmitReset
