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Welcome to Men Mentoring Men (M3). Your participation in this organization is an opportunity to explore the male experience by both talking about your life and providing your life-acquired wisdom to the benefit of other men. In order to ensure greater communication, please provide us with the information requested below prior to attending the orientation meeting.

Your Name (required):

Street Address:

City: , Zip:

Phone:
Home (required) Work

Your Email (required):

Date of Birth: (MM / DD / YYYY)
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Marital Status:
 Married Single Divorced Separated

Name of Significant Other (if applicable):

How did you hear about Men Mentoring Men?

What would you like to get out of this experience?

Do you have prior experience in Men\'s Groups?
 Yes No

Are you in a personal crisis? (required)
 Yes No Somewhat

Are you in psychotherapy or counseling? (required)
 Yes No

Are you aware the M3 is not a counseling or psychological treatment center?
 I am aware

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Please note the information you have provided will remain confidential.
Thank you for completing this form and enjoy your decision to be a part of M3.