A-CAN EOI Form

Name*

First NameLast Name

Graduation Year*

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number*

Email Address*

University Email Address (Students Only)*

example@example.com

University Attended*

Undergraduate Degree*

Postgraduate Degree*

Were you a member of your university African-Caribbean Society (ACS)*

YesNo

Were you a committee member of your university African-Caribbean Society (ACS)*

YesNo

What position did you hold in your ACS committee?*

Current Employer*

Current Position*

LinkedIn Profile

Twitter Account

Add your CV if you'd like!

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