Fall 2022 Mentorship Program Registration First Name * Last Name * Gender * Female Male Non-binary No gender Prefer not to say Pronouns * She/Her/Hers He/Him/His They/They/Theirs Prefer not to say Title * Company * Email * Phone * State of Current Residency * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming I'm Interested in * Being mentored (I have 1-5 years experience) Being mentored (I have 6-10 years experience) Being mentored (I have 10+ years experience) Mentoring (I have less than 10 years experience) Mentoring (I have 10+ years experience) Mentoring (I have 20+ years experience) Topics I'm interested in mentoring/being mentored on (select all that apply) * Management Leadership Interviewing Skills Career Trajectory Public Speaking Business Development/Sales Customer Service Claims Adjudication Litigation Underwriting Data & Analytics Finance Human Resources Diversity & Inclusion Continuing Education Actuarial Skills Marketing Design Thinking Innovation IT and Technology Other (not listed above) I prefer to be paired with a * Male Female Non-binary Does not matter reCAPTCHA If you are human, leave this field blank. Submit
