Mentoring Application Form

MENTORING APPLICATION FORM

GENERAL INFORMATION
Name		Contact Numbers:
Surname		Cell Num
Email		Work Num
Church		Home Num
Current Job		Relationship Status	Married Single Divorced Widowed
Address		Relationship Status	Married Single Divorced Widowed
Date of Birth	Day Month Year
Are you a member at DFC	Yes No
Gender	Male Female

Have you done mentoring before?	Yes No
Who was your leader?
Do you want to be with someone specific?
Would you like to stay with your 2011 leader?	Yes No
Which group would you like to attend?	Evening group Morning group with toddlers (ages 0 -3) Morning group without toddlers

FINANCES

There is a once off fee of R200 payable on registration. Please note that this excludes your year-end function and resources that are optional to purchase

MENTORING COMMITTMENT

·         I commit to come to the monthly meeting
·         To pray with someone in person, or on the phone twice a month
·         To be involved in a mercy project.

Please fax or email proof of registration payment to: 021-9792800 or accounts@dfc.org.za

Note that registration payment secures your place in a group.

Mentoring Banking details:
DFC Mentoring | ABSA | Branch Code: 632005 | Santyger | Account number: 920 268 6665
Ref: Family Number_2012 or Name and Surname_2012

DISCLAIMER

I do not want to receive Durbanville Family Church related communications by:

Phone Sms Email Family Statement (e-statement)

By completing this form you have indicated on your application form whether or not you want us to contact you to inform you about Durbanville Family Church related news, information and family e-statements.

Should you wish to change your options at any point, you can send an email to info@dfc.org.za or contact us at 021 979 2803 that registration payment secures your place in a group.