| First Name | |
| Last Name | |
| Home Local Committee | |
| Graduation Year | |
| ZIP / Postal Code | |
| Role(s) held while in AIESEC (check all that apply) |
Member, Student / Regional Director, Local Committee Executive Board, Local Committee President, AIESEC International, Trainee |
| Year Joined AIESEC | |
| City / Town | |
| State / Province | |
| Country | |
| Employer | |
| Industry | |
| Traineeship Year (if applicable) | |
| Company Website |
