Young MD Cultivate

Young MD Mentorship 2021- Aspiring Mentor

Dear Doctor,

Thank you for your interest in becoming a Young MD Mentor. We greatly value your keen interest and wish to engage further with you about the Young MD mentorship programme. Please fill out your details and our team will get back to you. Kindly note that you will receive no confirmation on completion of this email. Should you wish to follow up please email youngmdza@gmail.com

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* 1. Please fill out the following details:

Name and Surname

Email address

Cellphone

Speciality/ Discipline

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* 2. How much time are you willing to avail to the mentorship programme per week?

Uncertain

30 min-1 hour per week

1 - 2 hours per week

2 - 3 hours per week

1 hour every 2 weeks

1 hour per month

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* 3. Do you have a gender preference for a mentee?

Female

Male

Both