APPLICATION TO JOIN ATMIA CONSULTING & TRAINING PROGRAM

Instructions: Fill out the form to apply to be part of the ATMIA Consulting & Training program. If a question is not relevant to you, please put N/A for not applicable in the required field. Required fields are in BOLD.

*First Name:

*Last Name:

*Email Address:

*Phone Number:

*Company Name:

*Address:

Address 2:

*City:

*Zip/Postal Code:

*Country:

Website:

*Nature of Business:

*Professional Qualifications:

*Business Experience:

Experience in ATM Sector:

Consultancy Services areas of expertise/experience:

Training Services areas of expertise/experience:

Business References

*Reference #1 Name:

*Phone (include country code):

*Email Address:

*Affiliation with this person:

Reference #2 Name:

Phone (include country code):

Email Address:

Affiliation with this person:

*I have read the above Code of Conduct and agree to:

Agree

*Code of Conduct Agreed on upon this date:

As part of our program, our consultants have the opportunity to become ATMIA endorsed consultants. This is accomplished through several formats. Further information on this will be sent once approved.

* I have read and agree to the ATMIA terms of use and privacy policy