AANA Members Interested in Being a Mentee

AANA Members Interested in Being a Mentee
Name:*

PrefixFirst NameMiddle NameLast NameSuffix
Email Address:*
example@example.com
Phone Number:

Area CodePhone Number
Time Zone:
State:
AANA Member Type:*
Years in Practice?*
Type of Practice?*
Primary Preferred Joint(s) (select all that apply):

ElbowFoot/AnkleHipKneeShoulderWrist
Nonpracticing Joint(s) (select all that apply):

ElbowFoot/AnkleHipKneeShoulderWrist
To assist us in matching mentors with mentees, please fill out the following:
Residency Program Name:
Fellowship Name (if applicable):
What quality, characteristic or aspect of a potential mentor is most important to you?

0/200
What is the most important factor of mentoring you are looking for?

0/200
Specific goals you are looking for with mentorship?

0/200
Please identify your top two preferences for mentor pairing such as same gender, similar location, same practice type, etc.

The Membership Committee will do their best to pair with these preferences in mind.
First Preference?

0/200
Second Preference?

0/200
Should be Empty: