Register to mentor - and enter to win! Here ...

As a mentor you can:

• influence the career path of an aspiring doctor
• showcase your practice and community
• be eligible to earn ACRRM PDP points or RACGP CPD points
• receive a $300 (+GST) honorarium per placement week
• mentor without undertaking any formal training or doing any formal reporting.

Register your interest in mentoring before 30 June, 2013, and you can also enter to win your choice of three great prizes.

Whether you are already a mentor in the John Flynn Placement Program - or intend to become a mentor - we invite you to register for the prize draw. 

Register by 30 June 2013 and enter the draw to win one of three great prizes!

• Full delegate registration to the Rural Medicine Australia 2013 conference in Cairns (valued at $980), or
• 3 online modules: Certificate in Primary Care Dermatology  (valued up to $1200), or
• An Alere InRatio INR testing monitor (ARTG 162335) plus a box of test strips (ARTG 162331) (valued at $1000).

To eligible to become a John Flynn mentor and enter the draw:

• You are currently a GP or GP registrar
• Your practise is designated RA2, 3, 4, or 5

Terms and Conditions

Please read the terms and conditions: Terms and Conditions

Registration Form

Your details

First name: *

Last name: *

Email address: *

Phone number: *

Medical setting: - None -Aboriginal Medical ServiceBase HospitalCommunity Health ServiceGeneral PracticeRFDSOther

Please select the main setting in which you practice

ABN:

Practice details

Practice name: *

Practice address: *

Practice phone number: *

In what RA is your practice located?: *

RA 2

RA 3

RA 4

RA 5

Practice manager's name: *

Practice manager's email: *

Mentoring information

Are you currently a JFPP mentor? : *

Yes

No

How many students do wish to mentor?: *

0 new students (existing mentors only)

1 new student

2 new students

3 new students

4 (or more) new students

Competition Entry

I wish to enter the prize draw for: *

Full delgate registration to the Rural Medicine Australia 2013 conference in Cairns (valued at $980), or

3 online Certificate in Primary Care Dermatology modules (valued up to $1200), or

An Alere InRatio INR testing monitor, plus a box of test strips (valued at $1000)

Declaration

I am a General Practitioner (or General Practitioner Registrar) practising in RA2-5 and I underatand that I must take my first student placement before 30 June 2014. I have also read and agree to the competition terms and conditions 

Agreement: *

I agree to the above declaration

Community Contacts

Community Contacts support the JFPP students and arrange social interaction for them during their placements. If you are unable to suggest a Community Contact, or there is no Community Contact in your area, the JFPP will arrange one.

Can you suggest a community contact:

Yes

No

Please contact me to receive details of a potential community contact:

Yes

Potential community contact name:

Potential community contact phone number:

Potential community contact email:

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