2022 CTSC Health Hackathon Mentor Registration

2022 CTSC Health Hackathon

Mentor Registration

First Name*

Last Name*

Credentials

Affiliation/Dept/Company

Role/Title

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Email*

Cell Phone

Primary Field/Industry

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Skillset

T&C*

Days Attending

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

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What Inspires you to be a Mentor?

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Photo Waiver*

Contact Release*

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

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Expectations

Dietary Restrictions

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Food Allergies

Send me a copy of my responses

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