Thank you for your interest in participating in the Mentorship Program for General Surgery Residents interested in colorectal surgery.

The program expectations are to complete at least 3 virtual or phone meetings over a 1 year time period and provide feedback on the program and your experience.

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* 1. Name and Email 

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* 2. Institution / Practice Information

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* 3. Are you a colorectal surgery fellowship/residency program director or associate program director?

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