Only completed forms will be considered for VIP status at the ChannelNext Event. Only One attendee is allowed per company.

Solution Provider West, 2010 Qualification Form

Please complete the following form to apply for your FREE VIP attendance to the upcoming ChannelNext event in your region. It is a value savings worth over $3,000 including hotel accommodations, all meals, drinks and activities. More importantly, you will network with many leading as well as emerging vendors to negotiate partnerships that will profit your company well into the future. ChannelNext may be the one activity this year that will benefit your company the most! Only completed forms will be considered for VIP status at the ChannelNext Event. Only one attendee is allowed per company. Spouses may attend select activities within event with pre-approval. Only 50 FREE VIP passes are available per event so please apply today if you do not want to miss this unique business opportunity.

Some of the information provided on this form will be included in the Event Guide which will be distributed at the ChannelNext Event.

Priority Code:	(leave blank if not applicable)
First Name
Last Name
Title
Company
Address
City
Province	Select your province Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Québec Saskatchewan Yukon
Postal Code
Telephone
Fax
Email
Web Site
Have you attended any other ChannelNext event in the past 12 months? Yes No
1. How do you best describe your business? Select One Value-added Reseller Systems Integrator Communication/Network Integrator Consultant Systems and Softwware Developer Corporate Reseller or Solution Provider Value-added Dealer System Builder ISP (Internet Service Provider) Other
2. Average Unit System Sales per Month:   Servers   Notebooks/Tablets   Desktops   Handhelds   Operating Systems
3. Territory Select Local Regional National Global
4. Please list the number of locations for your distribution/sales offices:   Number of locations   City and Provinces
5. Number of years in business:
6. Number of Employees:
7. Which of the following best describes your firm’s primary and secondary business? Primary (checkk one) Secondary (check all that apply)   Large/Enterprise (1000+ employees) Mid-Market (100 to 999 employees) Small Business/SOHO (1 to 99 employees) Network Infrastructure Security Solution Provider Storage Solution Provider Systems Integrator Managed Services Government Education Mobility
8. Annual revenue: Select Under $500K $500,000 to $1 Million $1 Million to under $5 Million $5 Million to under $10 Million $10 Million to under $50 Million $50 Million to under $100 Million $100 Million to under $500 million Over $500 Million
9. Vertical Markets (check all that apply)   Construction     Education     Engineering/Scientific     Entertainment/Media Publishing     Federal Government     Financial Services/Accounting     Healthcare/Medical/Dental/Pharmacy     Insurance     IT Security     Legal     Manufacturing     Provincial/Local Government/Public Sector     Real Estate     Retail     SAN/NAS     Telecommunications     VOIP     Other
10. Of the products your organization sells, what percentage is purchased from:   Distributors %   Direct from Manufacturers %   Other Resellers/Solution Providers %
11. Name your primary and secondary distribution partners:   Primary   Secondary
12. List below any Vendor Program Affiliations and Certifications. Format: Vendor: ProgamName/Certification Level (example: HP: Partner Program/Gold Level)
13. List Key brands of components and peripherals sold
14. List below any Awards/Honors or Recognition your organization has received:
15. Name the top 3 Vendors you would like to see on the roster at ChannelNext:   1.     2.     3.
16. Name your 2 key challenges as a reseller:   1.     2.
For Security Purposes, please enter the following code
By submitting this applicatoin, I agree to the following: By submitting this participation request form to attend the upcoming ChannelNext event, you agree that if you are accepted to attend for FREE and you do not cancel your acceptance within 7 days of receipt, that you must attend or you will have to pay a no-show cancellation fee of $750. No cancellations will be accepted within 4 weeks of the posted event date. You will receive a no-show form for you to complete with your credit card information authorizing us to bill you for $750 for no-show. All registrations that do not complete the no-show credit card authorization form or have not provided an agreed form of payment guarantee, will not be guaranteed their place at the event, but will still be responsible for the full no-show payment. VAR acknowledges that the application submitted to Technoplanet accurately represents their business. Precedence will be given to resellers who have not attended ChannelNext in the past two years. VAR acknowledges that they must attend all mandatory sessions.