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:   1. Services Provided Consulting PLU Store Equipment Sales Data Communications POS Hardware Systems Integration e-commerce POS Installation Supplies Loss Prevention Project Management 2nd Market Equipment Maintenance Scanning Training Payment Systems Software Wiring Other:     2. Geographic Coverage:     3. Retail Segment Specialty Department Store Restaurant/Food Service Drug Store Chain Specialty Home Center Supermarket/Grocery Mass Merchant/Discount All Other:     4. Equipment POS Terminals In Store Processor Platforms Other (please list) 4683 AS/400 4680/4690 4684 PC DOS 4693 PS/2 OS/2 4694 RS/6000 JAVA 4695 ATM Windows 2000 PS/2 Network Management Windows NT   SurePOS 500   Windows 98   SurePOS 700   AIX       Linux     Unix 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.