Membership Registration Form for the Board Club

This form cannot be submitted unless all required fields are completed *.
Return form by clicking on the submit button or print it and fax back to +44 (0)1945 581531. Please read our terms and conditions below before applying.

Your Details

Do you have a FTM PIN?	No If yes, please insert FTM PIN
Title
First Name *
Surname *
Position *
Company *
Address *


Town *
Postcode *
Country *
Email *
Telephone

Which market sectors do you serve? (Tick maximum of 3)

Job Function (Tick only 1)

Which technologies do you work with? (Tick all applicable)

Where did you hear about Future-Blox Boards?

Trade Press (State Title)

Terms and Conditions
Membership to the Board Club is subject to qualification. Future Electronics reserves the right to deny or cancel, without notice, any membership application or request for development boards. All Future Electronics Blox boards and third party development boards are offered subject to availability at the time of application. By applying for Board Club membership you are giving consent for Future Electronics and other Blox programme partners to contact you with offers that are deemed to be of interest to you. Your details will not be forwarded to any other companies. If you do not agree with these terms and conditions please tick the 'OPT OUT' box and return the form.

Aerospace/Military	Lighting/Signs
Amusement/Leisure	Medical
Audio/Video	Metering
Automation	Motor Control
Automotive	POS/Vending
Broadcast	Power
Computing	Fire/Safety/Security
Consumer/White/Brown gds	Telecoms/Datacoms/Networking
Embedded Control	RF/Microwave
Industrial Control	Other (Inc Supplier)
Instrumentation

Design	R&D
Production	Corp. Management
Purchasing	Tech. Management
Consultant	Other

AnalogueI/O	Power Supply
Digital I/O	RF
MCU	Passive
MPU	Interconnect
Memory	Emech
User Interface	Programmable Logic
Control ICs