AAHMS Mentorship Program Registration Please register your interest for the Mentorship Program below More information on the Mentorship scheme and selection process can be found at www.aahms.org/mentorship-program. Question Title * Given Name Question Title * Surname Question Title * Primary email address Question Title * Preferred telephone number Question Title * Which state do you reside in? ACT NSW NT QLD SA TAS VIC WA Question Title * Do you visit another state regularly? If yes, which state/s? ACT NSW NT QLD SA TAS VIC WA Question Title * What is your primary discipline? Question Title * What is your research focus? Question Title * Apart from your primary discipline and research focus, what areas of expertise can you/would you like to Mentor in? Clinical Trials Collaborating with industry Creating a research speciality Dealing with ethical and moral issues within research Developing a strong publication record Managing internal politics and challenging work relationships Media engagement Moving into a new research field Navigating the research policy arena/working with government Patient engagement Public engagement and science communication Refocusing your research speciality Retraining skills Returning to academia from industry Successful grant applications Teaching Working on large/international collaborations Work/Family balance Other (please specify) Question Title * Thank you for registering your interest. If you have any questions, contact mentorship@aahms.org. Submit