This form is used for new participants only! If you are a current AmerEx program participant, you must log into your account in our online system AXIS and communicate your questions through the Comments section. If this is a serious emergency that requires our attention, please use the emergency toll free number that has been provided to you.

Contact (First & Last Name):
Telephone Number:
Email Address:
City, State:
Interest (please check all that apply):	Work & Travel Internship / Trainee H-2B
When are you interested in participating? (mm/yyyy to mm/yyyy):
Have you ever participated in any exchange programs to the U.S.?:	Yes No
Please provide detailed explanation of your interest, whether you are already working with an agent in your home country and other reasons for your inquiry so that we can respond to you in the best way: