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* 1. Title

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* 2. First Name

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* 3. Last Name

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* 4. Email Address

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* 5. Confirm Email

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* 6. Phone Number

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* 8. If you chose "Postdoctoral Clinical or Research Fellow", please indicate if you are registered as a Fellow with the Department of Psychiatry, University of Toronto

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* 9. Department

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* 12. Residents, Fellows and Graduate Students are encouraged to attend the Mentorship Breakfast, which will be held the morning of HSRD prior to the Keynote Address from 7:30 am to 8:30 am. If you wish to attend, check "Yes" then scroll down to complete the Mentorship Breakfast Survey below.

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* 13. Faculty volunteers are needed to share their academic experiences as mentors at the Mentorship Breakfast, involving roundtable discussions with mentees. The Mentorship Breakfast will take place prior to the Keynote Address at HSRD (7:30 am to 8:30 am). Please indicate if you are able to serve as a Mentor for this event.

If yes, please answer the following so that we can ensure a broad mix of mentors for the trainees.

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* 14. Are you an MD?

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* 15. Are you a PhD

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* 16. How many years since your first academic appointment?

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* 17. What is your area of research/expertise?

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* 18. Area(s) of experience that you would like to share?

Mentorship Breakfast Survey

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* 19. If you plan to attend the Mentorship Breakfast, please indicate your interest in the following topics ( 1=not interest at all, 5=very interested).

  1 2 3 4 5
How to get published
How to get a grant funded
How to get the most out of mentorship
How to get an academic job
How to balance work and life in academia
Discussion in a specific topic area (e.g. mood disorders, anxiety disorders, health systems)
Opportunities for networking and building collaborations
Equity and Gender in Academic Medicine

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* 20. If you are interested in a theme table discussing a specific topic area, please specify that topic area here:

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* 21. If there are other questions or dilemmas that you would like to discuss with Faculty in our Department, please list them here:

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* 22. Dietary restrictions*--All registrants please indicate any restrictions.

*We will do our best to accommodate dietary requests
Once you have selected "Done" and the page has changed to the Survey Monkey page, this will indicate your successful registration.

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