Wired Wessex March, 2010 Mentor Event
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1. Wired Wessex Mentor Request Form

Wired Wessex March, 2010 Mentor Event
Thursday, March 11th
6:00 - 9:00 pm
The Slug and Lettuce, 12/13 The Square, Winchester SO23 9ES
upstairs bar

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1. I am a Wired Wessex Member: (Priority will be given to Wired Wessex Members until Friday, February 12th.)

I am a Wired Wessex Member: (Priority will be given to Wired Wessex Members until Friday, February 12th.) Yes

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2. Full Name:

Full Name:

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3. Company/Organisation: (if you're not part of a company, type "None")

Company/Organisation: (if you're not part of a company, type "None")

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4. Email Address:

Email Address:

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5. Phone Number:

Phone Number:

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6. Choice of Mentor:

	Jane Buswell (Marketing)	Matthew Carey (HR)	Peter Czapp (Profit Improvement)	Garry Lane (Life/Career Coach)	Marlene Roche (HMRC/Tax)	Tony Treacy (eCommerce)	Whoever is Available
First Choice	*Choice of Mentor: First Choice Jane Buswell (Marketing)	First Choice Matthew Carey (HR)	First Choice Peter Czapp (Profit Improvement)	First Choice Garry Lane (Life/Career Coach)	First Choice Marlene Roche (HMRC/Tax)	First Choice Tony Treacy (eCommerce)	First Choice Whoever is Available
Second Choice	Second Choice Jane Buswell (Marketing)	Second Choice Matthew Carey (HR)	Second Choice Peter Czapp (Profit Improvement)	Second Choice Garry Lane (Life/Career Coach)	Second Choice Marlene Roche (HMRC/Tax)	Second Choice Tony Treacy (eCommerce)	Second Choice Whoever is Available

Would you like to meet with more than one Mentor if time slots are available? (If you reply "Yes", your second choice will be your second mentor. You will be informed on Monday, March 8th if you will have a second Mentor appointment)

7. Choice of Time: (Tick all times that you're available)

Choice of Time: (Tick all times that you're available) Whenever you can fit me in!

6:00 - 6:30

6:30 - 7:00

7:00 - 7:30

7:30 - 8:00

8:00 - 8:30

8:30 - 9:00

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Wired Wessex March, 2010 Mentor EventExit this survey

1. Wired Wessex Mentor Request Form

*1. I am a Wired Wessex Member: (Priority will be given to Wired Wessex Members until Friday, February 12th.)

*2. Full Name:

*3. Company/Organisation: (if you're not part of a company, type "None")

*4. Email Address:

*5. Phone Number:

*6. Choice of Mentor: