AACMA Mentoring Program - Mentee Registration Form Thank you for your interest in participating in AACMA Mentoring Program! Before complete this form, please kindly note that the Mentee Registration, at this stage, is ONLY open to final year students / new graduates who are in their first year out of graduation. Question Title * 1. Name Question Title * 2. AACMA Member Number (if known) Question Title * 3. Email Address Question Title * 4. Contact Numbers Work Mobile Home (optional) Question Title * 5. Contact Address - Full Address Question Title * 6. Professional Interest Areas Question Title * 7. Preferred Means of Communication Email Mobile Conference Call Meeting in person Other (please specify) Question Title * 8. Preferred Frequency of Communication with Mentor 1-2 times per month 3-5 times per month More than 5 times per month Question Title * 9. Expectations / What I hope to achieve by being a mentee? Question Title * 10. I will read the program manual and agree to abide by all program, AACMA and CMBA requirements and guidelines. Yes No Thank you for your registration! You will be in touch with AACMA national office later regarding your registration. Question Title Australian Acupuncture and Chinese Medicine Association Ltd Suite 1, 1990 Logan Road, Upper Mount Gravatt QLD 4122 Phone: 07 3457 1800Web: www.acupuncture.org.au Done