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.
Name

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* 1. Name

AACMA Member Number (if known)

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* 2. AACMA Member Number (if known)

Email Address

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* 3. Email Address

Contact Numbers

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* 4. Contact Numbers

Contact Address - Full Address

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* 5. Contact Address - Full Address

Professional Interest Areas

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* 6. Professional Interest Areas

Preferred Means of Communication

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* 7. Preferred Means of Communication

Preferred Frequency of Communication with Mentor

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* 8. Preferred Frequency of Communication with Mentor

Expectations / What I hope to achieve by being a mentee?

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* 9. Expectations / What I hope to achieve by being a mentee?

I will read the program manual and agree to abide by all program, AACMA and CMBA requirements and guidelines.

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* 10. I will read the program manual and agree to abide by all program, AACMA and CMBA requirements and guidelines.

Thank you for your registration! You will be in touch with AACMA national office later regarding your registration.

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Australian Acupuncture and Chinese Medicine Association Ltd

<div style="text-align: left;"><span style="color: #000000;"><strong><span style="font-size: 12pt;">Australian Acupuncture and Chinese Medicine Association Ltd </span></strong></span></div>
Unit 1, 55 Clarence Street COORPAROO QLD 4151
Phone: 07 3457 1800 | Fax: 07 3394 2399
Web: www.acupuncture.org.au

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