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Health Law Mentor Program | Mentor Sign up Form

MSBA Health Law Mentor Program Sign-Up Sheet

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	Note that fields with * are required.
Name of Attorney:*
Firm:
Title:
Email:*
Telephone:*
Nature of Job or Practice:
Types of Issues, Matters Most Often Handled:
Member of the Maryland State Bar Association? Yes No
Member of the MSBA Health Law Section?          Yes No

Level of Commitment (Check at least one)
	I agree to serve as a mentor to one law student.
	I agree to serve as a mentor for a group of law students, not to exceed
	I agree to serve on a panel of attorneys who agree to accept telephone calls or emails from law students who have questions about the following areas of health law or career choices:
	I agree to host law students(s) for a "shadow" day or afternoon at my law office
	I agree to make myself available to law student(s) as follows: