SecondAbility Mentors Membership Agreement Form

Please fill out the form below and check the box confirming you have read and understood the SecondAbility Mentors Code of Conduct
and the SecondAbility Mentors Membership Agreement, further; you understand that failure to follow the above rules may lead to my ejection from the SAM group.

Digital Signature
	SecondLife
Avatar First Name: (Required)
Avatar Last Name: (Required)
E-Mail: (Optional)
SL Wiki page: (Optional)
SL Memberships: (Optional)	I am a Second Life Mentor
	Real Life (Optional. However, providing city and state and/or country can help us make sure we have better mentor coverage at all hours.)
City:
State:
ZIP Postal Code:
Country:

I have read, understand, and agree to the above.

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