JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Advocacy Mentorship Program Sign-Up
Are you a WPSR member willing to share your activism experience with an aspiring health advocate?
Are you someone who is concerned about threats to health and looking to learn how to be an effective health advocate?
WPSR's Advocacy Mentorship Program matches experienced advocates with aspiring future advocates to learn how health professionals can use their trusted and credible voices to educate others, influence decision-makers, and have an impact on the issues that matter most for our health.
Sign Up Below!
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Name
*
Your answer
Email
*
Your answer
Phone Number
*
Your answer
Where are you based? Where's work/where's home (optional)
Your answer
Interest Area
Climate
Nuclear Weapons/Anti-Militarism
Economic Inequity
Other:
I'm interested in being a:
*
Mentor
Mentee
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of WPSR.
Report Abuse
Forms