Phenomenal Men Support Group, Inc.
Helping Men to Recover and Develop Productive, Responsible Lifestyles
3020 West Vliet Street, Milwaukee, Wisconsin 53206 414-305-1518 / Fax 414-354-5639
Official Registration Form for the Young Warriors Mentorship Program
Who Do You Live With?
Mail To:
PMSG National Headquarters
C/O WAAW
3020 West Vliet Street Milwaukee Wisconsin 53208

Email to: chairman@pmsginc.org

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CHECK all the Activities You Would Like to do.
UNDERLINE The Best Possible Answer From Each Group of Questions.
UNDERLINE ONE ANSWER ONLY
If your friend wanted to hurt a girl just for fun you would most likely ......
UNDERLINE ONE ANSWER ONLY
If your friend believed that a man could only be respected if he had cars, bling and girls, you would most likely .........
UNDERLINE ONE ANSWER ONLY
If your friend wanted to get out of a gang you would most likely .........
UNDERLINE ONE ANSWER ONLY
If your friend wanted to smoke cigarettes, drink alcohol or use drugs you would most likely ......
Continue being their friend
Stop being their friend
Don't know
Support his decision
Persuade him to stay
Don't know
Disagree with him
Agree with him
Don't know
Mom
Dad
Parents
Mom & Stepdad
Dad & Stepmom
Grandmother
Grandfather
Grandparents
Other Relatives
Group Home
Foster Family
Friends
Other
Yes, I have been to jail
No, I have not been to jail
I want to know how to be a man  
I already know how to be a man                                
I get mostly A's and B's
I get mostly C's
I get mostly D's and F's
I dropped out of school
Basketball
Chess Club
Softball
Football
DJ
Boxing
Rap Music
Wrestling
Karate
Swimming
Church
Business
Soccer
Art/Crafts
Musical Instrument
Singing
Fishing
Skating
Bowling
Dancing
Other -- Be specfic
Tell him you want no part in it
Help him come up with a plan
Don't know