Mentoring Registration Form

Title/Role and Company
Title/Role and Company
Please complete a short summary of your career history and experience (200 words or less).
Preferred meeting location

Age Range

I would like to be involved in the mentoring program based in:

Any specific challenges or goals? What do you hope to gain through this mentoring program?
For further information about the program, please email Julie Egonidis or via telephone on (03) 9654 4900.  

How did you hear about this program?

Commitment to group sessions is important to ensure the most effective mentoring program and mentoring relationships.  There are three formal sessions scheduled for each state.  Each session will be a morning workshop of 2 hours, including breakfast.   Where possible we would ask for attendance at all sessions located in your respective state.

The Faculty has a Privacy Policy to ensure that it handles private information about individuals responsibly. The Privacy Policy is available at and may be amended from time to time.