Mentor Registration

Please enter the information requested below

Introduction

The first step in entering the A.H. Nickless Innovation Award competition is to create a Mentor Profile.

Before entering any information, please download and read the Official Rules and Regulations of the Award.

NOTE: Bold fields are required.

Personal Information

Personal Information

Please enter the information requested in each space. Privacy: Please read our privacy statement regarding the personal information entered on this form.

  State: MI  Zip Code:
  Cellphone:
  Gender: Male  Female

Login Password

LogIn Information

You will be using your email address and password to access your profile. Please write down the information you enter for future reference.

(A combination of six to 10 letters and/or numbers. Include at least one uppercase letter and one number.)
Agreement
Verification

Verification Information

Type the characters you see in the picture. This ensures that a person, not an automated program, created this profile.