If you are interested in registering as a mentor, we ask that you fill out and submit this registration form as soon as possible.

Please note, Mentorship is open to ONLY Graduate and Postgraduate Students.

Registered Mentors must be available to attend the Undergraduate Luncheon

Upon submitting the form, you should receive a confirmation email verifying your registration and information. If you do not receive an email, or need to change your information please send an email to

smm_student_workshop
@hotmail.com


Last Name*
First Name*		 Male
Female

Email Address*


College/University Affiliation*



Address Line 1


Address Line 2

City
State/Province

Country
Postal Code
What is your current academic status?*

What is your nationality?
What languages do you speak ?
Which of the following "fields" would you like to be listed in as a Mentor (Limit 3) ?*
*Required