Date: Wed, 25 Sep 96 12:21 PDT

To: pr.bruxelles@agora.stm.it

From: rie@netbistro.com (Anne-Marie)

Subject: Fast for Gedhun Choekyi Nyima

APPLICATION FORM FOR THE FASTING DIALOGUE

(X) I will participate in the fasting dialogue for the liberation of Gedhun Choekyi Nyima, XIth Panchen Lama, and of the Chinese dissident Wei Jingsheng.

* I have the intention to fast ( ) 1 Day

( ) 2 Days

(X) 3 Days

* We would like to know the dates of your fasting:

(X) September 30th

(X) October 1st

(X) October 2nd

Name: Anne-Marie Cowsill

Complete address: RR#5, Site 10, Comp. 2 - Prince George, BC

Country: Canada

Telephone: 604-963-7638

e-mail: rie@netbistro.com

Profession/function: Youth Worker