LEAD Mentorship Programme: Mentor application

Please complete the form below. NB: Complete and submit it promptly or the 4 digit code at the end may not be recognised and you will have to refresh (F5) and resubmit.

* Last Name:

* First Name:

* ID number (13 digits - no spaces):

* Gender (for reporting purposes only):

Female

Male

* Name of law firm :

* Cellphone number:

* E-mail address:

Office telephone number:

* Physical address and postal code
This is the address you will be
using as a base for mentorship.
i.e. You will be mentoring at this address:

* Province:

* Race (for reporting purposes only):

African

Coloured

Indian

White

Law society membership number
The LSSA reserves the right to check
whether an attorney is in good
standing with his/her law society:

Year admitted as an attorney :

* Choose ONE area of mentorship:

Practice development

Conveyancing

Specialisation of women practitioners in litigation and commercial law

Good standing:

Yes

No

How did you hear about the mentorship programme?:

LSSA or LEAD website

Significant Leadership Mentorship Network for Women Lawyers

Social media

Other

Number Verification:

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