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* 1. Contact Information

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* 2. Please list what you would like to learn from your mentor

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* 3. Do you have a preference that your mentor works at an agency or corporation?

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* 4. What time of day would you prefer to meet with your mentor?

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* 5. Do you have a mentor in mind that you would like to be paired with? If so, who?

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* 6. Do you have any suggestions for this year's mentor program?

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* 7. PRSA membership is required to participate.

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