Are you a seasoned member of ASRM who has attended several ASRM Annual Meetings? Would you enjoy meeting and mentoring new ASRM members or first-time Annual Meeting attendees?

Help first-time meeting attendees by joining ASRM’s mentoring program and getting paired with a mentee who would welcome an opportunity to meet and learn from you! 

The Annual Meeting Mentoring Program offers a voluntary, informal relationship between mentors and mentees. We will match mentors and mentees based on practice information, professional interests, desired time commitment and previous involvement with ASRM. 

If you would like to meet and share your knowledge with new ASRM members at the 2013 Annual Meeting, please complete the form below to apply for the mentoring program no later than August 15, 2013.

Questions? If you need more information about the Annual Meeting Mentoring Program, please contact Jaclyn Decker at jdecker@asrm.org or (205) 978-2000, ext. 134.

Full Name: 
 

ASRM ID: 
 

Street Address: 
   

City: 
    

State: 
    

Zip: 
 

Phone: 
 

Email: 


 

Preferred Method of Contact:   

                                   

Profession: 

                                  

Practice Specialty: 

             

Are you willing to be paired with a mentee who is not in your specialized field? 

 


 

Please list all the specialties that you are willing to mentor:    


Spoken Languages:   

 

Please briefly describe why you want to be a mentor:   
 

 

Which of the following best describes the time you are willing to commit to mentoring at the Annual Meeting? (This will help us match you with a mentee based on program expe.) 

                                          

Are you interested in learning about additional volunteer opportunities to help new members and first-time attendees? 

             

 

 

Back to Top