WHPC Mentoring Programme Pre-Application
Please complete this form if you are interested in participating in the WHPC Mentoring Programme, either as a mentee/protége or mentor. You are welcome to indicate that you would like to be both a mentee and mentor.

The information submitted in this form will only be available to the WHPC Mentoring Programme Chair and the WHPC Executive Board. Your answers will never be passed to a third party and will only ever be used in the context of the WHPC mentoring programme.

First (preferred) name *
Your answer
Last/family name *
Your answer
Email address *
Your answer
Telephone number (this will only be used if we are unable to contact you by email, for example if our emails end up in your spam folder!). Please include your country code. *
Your answer
I would like to be (select all that apply) *
Required
Are you a member of WHPC? (N.B. you can join online for free at http://eepurl.com/dcrjFf) *
Why do you want to be part of this programme? *
Your answer
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