First Name
Last Name
Email
Country Afghanistan Åland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire sint eustatius and saba Bosnia and Herzegovina Botswana Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cabo Verde Cambodia Cameroon Canada Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (keeling) Islands Colombia Comoros Congo Congo, Democratic Republic of the Cook Islands Costa Rica Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-bissau Guyana Haiti Holy See (vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea, Democratic People's Republic of Korea, Republic of Kosovo Kuwait Kyrgyzstan Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia, The Former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States of Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory, Occupied Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Réunion Romania Russian Federation Rwanda Saint Barthélemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin (French Part) Saint Pierre and Miquelon Saint Vincent and The Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maartin (Dutch Part) Slovakia Slovenia Solomon Islands Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States of America United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vietnam Virgin Islands, British Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe
What is your time zone? US - Alaska Time US - Central Time US - Eastern Time US - Hawaii-Aleutian Time US - Mountain Time US - Pacific Time Europe - Greenwich Mean Time (GMT) Europe - Central European Rime (CET) Europe - Eastern European Time (EET) Middle East - Egypt Standard Time Middle East - Eastern European Time/Israel Standard Time Middle East - Eastern European Summer Time/Israel SummerTime Middle East - Arabia Standard Time / Turkey Time Middle East - Iran Standard Time Middle East - Gulf Standard Time Africa - Cape Verde Time Africa - Greenwich Mean Time Zone, Western European Time Zone and Western Sahara Time Zone Africa - Central European Time Zone and West Africa Time Zone Africa - Central Africa Time Zone, Eastern European Time Zone, and South Africa Time Zone Africa - East Africa Time Zone Africa - Mauritius Time Zone Africa - Reunion Time Zone Africa - Seychelles Time Zone Australian Western Standard Time (AWST) Australian Central Western Standard Time (ACWST) Australian Central Standard Time (ACST) Australian Eastern Standard Time (AEST) Australian Lord Howe Standard Time (LHST) Asia Other
Company Name
Please select the mentorship you are most interested in. Select all that apply. MentorMenteePeer to Peer Mentorship
WIAT is open to all those that support women, not just women, therefore we do have male mentors within the programme. Would you be happy to be paired with a male mentor/mentee? Yes No
What is your current job role and what does this entail?
What are your personal ambitions?
Why do you want to join the WIAT mentor programme?
What does a good mentor/mentee relationship look like to you?
What topics would you like to discuss in a group/round table setting? The answers will be used as a guiding basis for the virtual discussions taking place throughout the mentorship programme.
What formats of face to face networking do you find most beneficial? Select all that apply. Informal networking drinks/dinnersRound table discussionsPanels with Q&AKey note speaker talksOther
If other, please specify.
Business Communications I confirm that the contact information I have given is for the purpose of business communications.
Privacy Policy I confirm that I have read and accept the Privacy Policy.
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