PC/104 Consortium Membership Application Form

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Use this form to begin your application to the PC/104 Consortium.

Simply fill in the blanks and press the SUBMIT button at the bottom of the form. An E-mail message containing your application will automatically be created and sent to the PC/104 Consortium.

Name:
Title:
Organization:
Address 1:
Address 2:
City:
State:
Zip/Mail Code:
Country:
E-Mail Address:
Phone:
Fax:

Message:

I am interested in the following membership category:
Observer member
Affiliate member
Associate member
Executive member

I found out about you from:
Internet Newsgroup
Internet search engine
Magazine
Friend
This way:

I am a:
Potential user of PC/104 products
Potential vendor of PC/104 products
Current user of PC/104 products
Current vendor of PC/104 products

I think the PC/104 on-line information is:
Absolutely Great!
OK
No Good


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