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* 1. BSG membership number (to be eligible you must be a member of BSG):

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* 2. Contact Information

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* 3. Career Stage

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* 4. Areas of Interest (multiple options possible)

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* 5. What support would you like to provide to a mentee? (multiple options possible)

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* 6. What is your preferred method of contact?

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* 7. How much time would you like to spend on the programme?

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* 8. I declare that I will send my CV to era@britishgerontology.org

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* 9. I agree to abide by ERA’s mentor scheme code of conduct
I agree to my data being shared with the ERA Committee and held for the duration of my involvement with the scheme
I agree to my CV being sent to the mentee that I am matched with

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