Connector for HBA Mentoring

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* 1. Contact information

Name *

Company

Title

Email Address *

Phone Number

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* 2. Region in which you'd like to be a Connector

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* 3. Are you an HBA member?

Yes

No

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* 4. Have you participated in the HBA Mentoring Program in the past?

Yes, as a mentor

Yes, as a mentee

Yes, as a connector

No, I've not participated in the HBA Mentoring Program