AACMA Mentoring Program - Mentor Registration Form

Background

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* 1. Name

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* 2. AACMA Membership Number

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* 3. Email Address

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* 4. Contact Numbers

Work

Mobile

Home (optional)

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* 5. Contact Address - Full Address

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* 6. Number of years employed in Chinese Medicine

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* 7. How many of these years were spent working part-time or less (20 hours or less)?

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* 8. How many hours per week on average are you currently employed in Chinese Medicine?

0-10

11-20

21-30

31-40

41+ hours