If you would like to be a Mentor in the AGEHR Area IX Mentor Program, please fill out the form below. You can help make the difference in a director's life by volunteering your time!

 

Please note that an asterisk (*) denotes a required field. If you do not have an answer for a required field, please type or select "N/A" or the number zero (0) in the blank.

Your First Name*
 

Your Last Name*

 

 

 

Organization

Organization's Street Address

City

State

    

Zip Code
  +

Organization's Telephone Number

Organization's E-mail Address

 

 

Your Home Street Address*

 

City*

 

State*

    

Zip Code*
  +

Home Telephone Number*

 

E-mail Address*

 

 

To contact me, please use my*       organization information  home information

 

I direct        choirs*(specify number of handbell/handchime choirs)
 

We have        octaves of handchimes.*

We have         octaves of handbells.*

 

My choir(s) consist of* (please check all that apply)

children (up to age 12 )

youth (ages 13-18)

adults (ages 18-50)
older adults (ages 50+)

 

My choir(s) ability level is* (please check all that apply)

beginner (level 1 and 2 music)

intermediate (level 3 and some 4 music)  

advanced (level 5 and above).

 

My music background is*

 limited amount of formal music training

some college music courses

college degree in music

 

My experience with handbells/handchimes is*

 1-5 Years

6-10 Years

11-15 Years

16-20 years

21+ Years

 

 

I feel that I would be a good Mentor because...*

(2,000 word limit)
 

 

I am willing to travel.....*

This many number            of        .

 

 

Please answer one of the following for COPPA Compliance*

  I certify that I am over 14 year of age.

AGEHR Area IX is COPPA compliant. Any information that we accept is volunteered by site visitors.

 

 

Please press the submit button only once.

 

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Last modified: 12/01/06