MENTEE REGISTRATION Name* First Last Address* City* State* Zip* Email* Work PhoneCell PhonePREFERRED CONTACT METHOD* Phone Text Email FaceBook CURRENT EXPERIENCE LEVEL* High School College Med Student Resident Fellow YPS INTERESTED PRACTICE TYPE* Private Practice Employed Academic Other INTERESTED SPECIALTIES* INTERESTED LOCATIONS WHICH MENTORSHIP ACTIVITIES ARE YOU INTERESTED IN PARTICIPATING IN?* Mentorship at Winter Medical Conference Mentorship at National Conference Telephone or Email Advice Shadowing Opportunities Research Assistance Interview Training CV/Cover Letter Review Specialty Choice Advice Test-taking Tips Other IF YOU ANSWERED "OTHER" FOR THE ABOVE QUESTION, PLEASE PROVIDE FURTHER DETAILS.*If you are interested in AAPI's Paid Observership Program for IMGs, please go to STUDENT OBSERVEE REGISTRATION
