MENTOR INTEREST FORM

I am interested in becoming a Mentor

Please provide us with your contact information and areas of interest below.
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
Your Age

20-29 yrs30-39 yrs40-49 yrs50-59 yrs60-69 yrs70-79 yrs80-89 yrs90-99 yrs
Which area is of most interest to you currently?*

godly manhoodbeing Christian in the business worldaccountabilitybasic discipleshipissues of strugglebeing a husband & father
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.
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I am interested in becoming a Mentor