AANA Members Interested in Mentorship
Name:
*
Prefix
First Name
Middle Name
Last Name
Suffix
Email Address:
*
example@example.com
Phone Number:
-
Area Code
Phone Number
Time Zone:
State:
Please select a state
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
AANA Member Type:
*
Select a Member Type
Active
Associate
Candidate
Resident
Fellow
International
Affiliate Allied Health
Senior
Emeritus
Years in Practice?
*
Please Select
0-5
6-10
11-20
21+
Type of Practice?
*
Please Select
Private
Academic
Hospital
Training
Other
Primary Joint(s) (select all that apply):
Elbow
Foot/Ankle
Hip
Knee
Shoulder
Wrist
Nonpracticing Joint(s) (select all that apply):
Elbow
Foot/Ankle
Hip
Knee
Shoulder
Wrist
To assist us in matching mentors with mentees, please fill out the following:
Residency Program Name:
Fellowship Name (if applicable):
What is the most important factor of mentoring you are looking for?
0/200
What can you provide for a mentee?
0/200
What quality, characteristic or aspects of your career may stand out to serve a unique group of mentees?
0/200
Submit
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