E-mail address:
Name:
Affiliation (institute/university):
Postal address:
Phone:
What describes you best?:	Undergraduate student Master's student PhD student Recent PhD/postdoc Lecturer or professor
What are you interested in? You may choose several options.:	Academic maths Maths in industry Balancing family life with a career in maths Maths education
Other interests:
Would you prefer your mentor to be a man or a woman?:	I would prefer my mentor to be a man I would prefer my mentor to be a woman I have no (strong) preference
Would you prefer your mentor to work in the same or in a different institute from you?:	I would prefer my mentor to work at the same institute I would prefer my mentor to work elsewhere I have no (strong) preference
How would you like to communicate with your mentor? You may choose several options:	Phone Email Skype In person
How often would you like to meet with your mentor?:	About once a month Once every few months
Do you have any specific questions already?:
Do you have any other matching preferences?:
Do you have any other questions or comments?:

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