SESA WO SUBAN MEMBERS FORM My Brotha’s Keeper International (MBK) Members Form First Name: Last Name: Phone Number: Email: Social Media Handles: Address: Zip code/Postal code: Country: Upload Profile pic (As clear as possible). Do you find it easier to express yourself one-to-one or within a group setting? 1-1 In a group On a scale between 1-10, where would you place yourself in a situation of taking accountability? 1 being the least accountable and 10 being the most accountable. 1 2 3 4 5 6 7 8 9 10 List 3-5 things you personally struggle with where you need support: On a scale of 1-10, how willing would you be to express your own vulnerability within the group? 1 being the least willing and 10 being the most willing: 1 2 3 4 5 6 7 8 9 10 On a scale between 1-10, how willing are you to break a cycle of self-destructive habits? 1 being the least willing and 10 being the most willing: 1 2 3 4 5 6 7 8 9 10 Send