E-mail address:
Name:
Affiliation (institute/university):
Postal address:
Phone:
Gender (Some mentees might specify preffered mentor gender):	Male Female
Who would you prefer to mentor?:	Undergraduate student Master's student PhD student Recent PhD/postdoc Lecturer or professor
What is the maximal number of people you would like to mentor?:	1 2 3 4 5 More
What would you like to give advise on? You may choose several options.:	Academic maths Maths in industry Balancing family life with a career in maths Maths education
Would you prefer your mentee to work in the same or in a different institute from you?:	I would prefer my mentee to work at the same institute I would prefer my mentee to work elsewhere I have no (strong) preference
How would you like to communicate with your mentee? You may choose several options:	Phone Email Skype In person
How often would you like to meet with your mentee?:	About once a month Once every few months I have no (strong) preference
Do you have any specific interests/areas of expertise?:
Do you have any other matching preferences?:
Do you have any other questions or comments?:

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