Associate Membership Application

*Organization Name:

*Delegate First Name:

*Address 1:

*Delegate Last Name:

Address 2:

*Title:

*City:

*Phone:

ext:

*State:

*Email address:

*Zip:

*Please re-enter your Email address:

Country:

Alternate First Name:

*Phone:

Alternate Last Name:

*Fax:

Title:

Company Homepage:

Phone:

ext:

* (required fields)

Email address:

Principal Type of Business:

IBM Business Partner:

Type of IBM Business Partner:

TYPE OF MEMBERSHIP:

Associate - An IBM Business Partner/provider of hardware, software, services in support of the IBM retail environment

Annual Dues $395.00

Associate membership plus link to your company's homepage

Annual Dues $695.00

EQUIPMENT AND SERVICES PROVIDED:

5. Annual Directory Information

This information is provided to all members at the conference in the annual directory. Please give a brief overview of services provided.