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2026-27 Mentor Program Acceptance

2026-27 Mentor Program Acceptance

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Email*

Enter Email Confirm Email

Name:*

First Last

Badge Name*

Your name as you would like it to appear on your badge.

First Last

ADA Requirements*

Please let us know if you have a request for any accommodations during the program.

Allergies | Specific Dietary Restrictions*

Please let us know if you have any allergies or specific dietary restrictions and we will do our best to accommodate you.

Program Fee*

I accept and am responsible for the Program Registration Fee of $2,250

Yes

No

Travel*

I also understand that I am responsible for my travel and accommodation costs related to all in person events held within the program.

Yes

No

Program Completion*

As a participant in ACCCA's Mentor Program, I agree to attend and complete the entire 1-year program with several virtual and in-person meetings.

Yes

No

Comments

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