Dear Applicant,

Thank you for your interest in the INS Mentorship Program, which pairs 8-10 practitioners who are early in their careers (Mentees) with highly qualified leaders in the field of neuromodulation (Mentors). Participating Mentee/Mentor pairs are expected to have contact at least quarterly to advance their stated goals, and to report on their activities.

The information you provide may be shared with the Mentorship Program coordinators, with INS chapter presidents in your location, and with prospective Mentors. However, you are expected to maintain the confidentiality of patient information, intellectual property, and information about the Mentor's practice. INS adheres to international privacy standards.

We look forward to advancing the practice of neuromodulation with you.


Alexios Carayannopoulos, DO, MPH, FAAPMR, FAAOE, FFSMB
Greg Bara, MD, MSc (Oxon)
Robert Bolash, MD
Sean Li, MD
Anh L. Ngo, MD
Jason Pope, MD
Moein Tavakkoli, MD, FRCA

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Question Title

* 1. I give permission for my contact details to be shared with the International Neuromodulation Society's (INS) executive leadership and administrative staff, INS Young Neuromodulator and International Women in Neuromodulation Committee members, INS chapter presidents in my location, and with prospective Mentors.

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