2022 CTSC Health Hackathon
Mentor Registration

First Name *

Last Name *

Credentials

Affiliation/Dept/Company

Role/Title

Email *

Cell Phone

Primary Field/Industry

Skillset

T&C *

Days Attending

Please let us know your availability, primary activities on Friday & Saturday

What Inspires you to be a Mentor?

Photo Waiver *

Contact Release *

Opt-In: Name & email may be released to Hackathon attendees if requested.

Expectations

Dietary Restrictions

Food Allergies

*

Send me a copy of my responses

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