Thank you for consideration of becoming a VQI mentor.  As a VQI mentor, you will be required to include a fellow in training (FIT) at quarterly meetings in which you participate in local quality improvement processes and include a FIT in participation at VQI Regional study group meetings. 

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* 1. I would like to serve as a VQI mentor:

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* 2. Please indicate which VQI activities you have presentation or publication experience in (check all that apply):

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