Date: 29 Sep 96 08:29:07 EDT

From: Christiane VERBEECK <101562.3313@CompuServe.COM>

To: Parti Radical

Subject: fasting

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 (x ) 2 Days

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

(x) September 30th

(x ) October 1st

Name: Christiane VERBEECK

Complete address: Nijvelsedreef 28 - 1150 BRUSSEL

Country: BELGIUM

Profession/function: pensioner

Declaration: "Through our support for Wei Jinsheng, let us do everything to help the Chinese people accede to democracy and to bring our governments to show more courage and support democracy and democrats in China. May Wei's life not have been sacrificed in vain.