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Membership Fees 2010

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Your Company Contact Details

Company Name:
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BUSINESS ADDRESS
Street Address 1:
Street Address 2:
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Company Telephone:
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Company Registration Number(CRO):
VAT Number:
VAT Exempt Cert. Number:

Primary Contact Person Details

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Your Position, please select:
Your Job Responsibility:
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Mobile Tel No:
Fax No:
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Billing Contact Details

If same as previous, please tick here:
If not, please complete the following:
Title:
First Name:
Surname:
Job Title:
Direct Tel No:
Fax No:
Direct Email Address:

Company Details

Please list the main industry sectors you provide solutions to:

	Agriculture
	Manufacturing - Food / Non-food
	Wholesale/Retail - Food / Nonfood
	Defence
	Public sector
	Foodservice/catering
	Transport/freight
	Healthcare
	Waste & recycling
	Other, please specify:

Please let us know of any relevant associations or accreditation programmes of which you are a member, including other GS1 Solution Provider or Alliance Programmes:

Is your company an EPCglobal subscriber?

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Yes
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Solution Provider Directory Information

Inclusion in the GS1 Solution Provider Directory is a KEY ELEMENT of your benefits package as a participant in the GS1 Ireland Solution Provider Programme. Please ensure you indicate which of the following should be included with your company description.

Barcode Solution Provider

	Artwork/image production (electronic and physical)
	Consultancy and training
	Printed labels
	Printing equipment Thermal Inkjet Laser Print and apply labels Consumables
	Readers (scanners)
	Software Number production Image production
	Systems integration
	Verification equipment (bar code quality control)

eCommerce Solution Providers (EDI)

	Consultancy and training
	Data communication software (transport, routing, packaging)
	Message translation software (EDI/XML)
	Systems integration
	Third party data exchange providers
	Value added networks (VANs)

GDSN Solution Providers

	Consultancy and training
	Data pools/catalogues
	Normalisation
	Other, please specify
	Validation hubs

Professional Services

	E-business
	Legal
	Supply chain management

RFID Solution Providers

	Consultancy and training
	Readers/writers Software
	Systems integration Tags

Supply Chain

	Accounting
	Asset management
	Collaborative planning, forecasting and replenishment (CPFR)
	Consultancy and training
	Enterprise resource planning (ERP)
	Point of sale/use
	Procurement
	Stock control
	Traceability
	Transport and distribution
	Warehouse management

Please describe your organisation in no more than 150 words. This will be your entry in the Solution Provider Directory:

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Additional Notes:

I hereby declare that the information given above is correct and by registering as a participant in the GS1 Ireland Solution Provider Programme, I agree to be bound by the GS1 Ireland Memorandum and Articles of Association. I understand that subscriptions are payable annually in advance unless the company formally resigns in writing. I agree to adopt the GS1 Ireland Solution Provider Code of Practice and accept that failure to abide by the Code of Practice may result in termination of our GS1 Ireland programme participation.

I understand and acknowledge that GS1 Ireland will make publicly available the information contained in this form:

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