MENTEE FORM

I would like to have a Mentor

Please provide your contact details and areas of interest in the form below.
Contact Info (will be shared with your assigned mentor)
Your Name*

First NameLast Name
Preferred Email Address*

Confirmation EmailBy providing my email address on this form, I give Church of the Rock permission to contact me by email. I understand that I can withdraw my consent at any time.
Preferred Phone*

Area CodePhone Number
City of Residence*
Which area is of most interest to you currently?*

godly manhoodbeing Christian in the business worldaccountabilitybasic discipleshipissues of strugglebeing a husband & father
Age Group

18-24 yrs25-29 yrs30-34 yrs35-39 yrs40-44 yrs45-49 yrs50+ yrs
Anything else you would like us to know? (Optional)
Please feel free to contact larissa@churchoftherock.ca / 204.261.0070 if you have any additional questions.
Should be Empty:

I would like to have a Mentor