<%@LANGUAGE="VBSCRIPT"%> <% Dim dthisDate dthisDate = Now() %> :: MiCTA - Technology Solutions for Non-profit Organizations ::
 



1500 W. High St.
Mt. Pleasant, MI  48858  
Voice (888) 870-8677
Fax (989) 772-3239  
membership@mictaservice.com

ATAlliance Participation Form
Please complete the following information:
Organization Name:
Primary Contact:
Title:
Area(s) of Responsibility:
Telecommunications Budgets/Finance Video Network/Equipment
Computer Services/Info Tech Purchasing LAN/Data Network
Other
Address:
City, State and ZipCode:
Country:
Phone:
Fax:
E-mail:
Organization Internet URL:
Institutional Information
Please indicate the size of your organization:     
  FTE Employees  
Please identify your main line of business that most closely represents your organization
College & University K-12 Government/Public Sector
Healthcare Library Other
 
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Second Contact:
Title:
Area(s) of Responsibility:
Telecommunications Budgets/Finance Video Network/Equipment
Computer Services/Info Tech Purchasing LAN/Data Network
Other
Address:
City, State and ZipCode:
Country:
Phone:
Fax:
E-mail:
Click here if you have no more contacts, or continue scrolling to add more.
Third Contact:
Title:
Area(s) of Responsibility:
Telecommunications Budgets/Finance Video Network/Equipment
Computer Services/Info Tech Purchasing LAN/Data Network
Other
Address:
City, State and ZipCode:
Country:
Phone:
Fax:
E-mail:
Click here if you have no more contacts, or continue scrolling to add more.
Fourth Contact:
Title:
Area(s) of Responsibility:
Telecommunications Budgets/Finance Video Network/Equipment
Computer Services/Info Tech Purchasing LAN/Data Network
Other
Address:
City, State and ZipCode:
Country:
Phone:
Fax:
E-mail:
Click here if you have no more contacts, or continue scrolling to add more.
Fifth Contact:
Title:
Area(s) of Responsibility:
Telecommunications Budgets/Finance Video Network/Equipment
Computer Services/Info Tech Purchasing LAN/Data Network
Other
Address:
City, State and ZipCode:
Country:
Phone:
Fax:
E-mail:
Please identify any additional personnel responsible for the following areas if not identified above.
A.  Telecommunications
B.  Budget/Finance
C.  Video Network/Equipment
D.  Computer Services/Info Tech
E.  Purchasing
F. LAN/Data Network
Survey Information
What is your primary reason(s) for participating in ATAlliance?
How did you hear about ATAlliance?
Are you a current member of or represented by any of the following organizations?
ACUTA MHEC
SREB WICHE  
 

Fax:(989)772-3239
Phone: (888)870-8677
E-Mail: membership@mictaservice.com

ATAlliance
1500 W. High St.
Mt. Pleasant, MI 48858
Attn: Clancy DeLong

 
 
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