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Annual Meeting Mentor Program Application  

2012 SME Mentor Program
Mentor Application Form

Deadline: January 20, 2012
*Required Fields
 
*Last Name
 *First Name
*Job Title
*Employer
*Employer Address
*City
 *State/Province
 *Country
 *ZIP Code/PC
*Business Phone
 Business Fax
*Email
 *Gender
Male Female
*College/University/Institution attended
*Degree(s) Earned
Outside Interests
 
Commodity Interest (indicate 2 in order of preference)
Primary Interest Secondary Interest
 
Discipline Interest (indicate 2 in order of preference)
Primary Interest Secondary Interest
 
Which do you normally attend during the SME Annual Meeting? (Check all that apply)
Keynote Session Welcoming Luncheon
Exhibit Coal Division Luncheon
Industrial Minerals Division Luncheon Mining & Exploration Division Luncheon
SME Dinner Environmental Division Breakfast
Mineral & Metallurgical Processing Division Luncheon
 
How many students are you willing to mentor? 1 2 3
Are you willing to stay in contact with your student(s)
for 1 year? 		Yes No
 
Specific Interest (indicate 3 in order of preference)
 
If possible would you like to have the same student from last year? Yes No
If yes please provde information below.
 
Student Last Name
 Student First Name
School
Phone
 Email
 
To confirm your identity please enter these letters/numbers below:
Enter the security code into the field below.
 
 



 
 
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