IBM WORLDWIDE OS/2 DEVELOPER ASSISTANCE PROGRAM APPLICATION
  ___________________________________________________________
 

  First Name                          Last Name
             _________________________          _________________________
 
  Title
        ______________________________________________________________
 
  Company
            __________________________________________________________
 
  Street Address
                   _______________________________________________________
 
  City                                     State            Zip
        ___________________________________       _________      __________
 
  Province                            Country
            __________________________         ___________________________
 
  Voice Phone                             Fax Phone
               ________________________             ________________________
 
  Electronic Mail Address
                          __________________________________________________
 
  Are you currently a member of an IBM
  authorized developer program?               [_]  No      [_]  Yes
 
  If yes, Country                       Membership Number
                   ____________________                    ____________________
 
  What category of developer are you?
 
  +------------------------+-------------------------+------------------------+
  | [_]  In-house          | [_]  Commercial         | [_]  Shareware or      |
  |                        |                         | similar                |
  +------------------------+-------------------------+------------------------+
  | [_]  Personal          | [_]  Other              |                        |
  |                        |             __________  |                        |
  +------------------------+-------------------------+------------------------+
 
  In what type of business are you?
 
  +-------------------------------------+-------------------------------------+
  | [_]  Government                     | [_]  Educational institution        |
  +-------------------------------------+-------------------------------------+
  | [_]  Corporate                      | [_]  Small business                 |
  +-------------------------------------+-------------------------------------+
  | [_]  Consultant                     | [_]  Other                          |
  |                                     |             __________              |
  +-------------------------------------+-------------------------------------+
 
  What type of software do you primarily develop?
 
  +-------------------------------------+-------------------------------------+
  | [_]  Word Processing                | [_]  Spreadsheets                   |
  +-------------------------------------+-------------------------------------+
  | [_]  Database                       | [_]  Integrated/Workgroup           |
  +-------------------------------------+-------------------------------------+
  | [_]  Graphics                       | [_]  Desktop Publishing             |
  +-------------------------------------+-------------------------------------+
  | [_]  Accounting/Personal Finance    | [_]  Information Management         |
  +-------------------------------------+-------------------------------------+
  | [_]  Utilities                      | [_]  Communications                 |
  +-------------------------------------+-------------------------------------+
  | [_]  Games and Entertainment        | [_]  Device Driver                  |
  +-------------------------------------+-------------------------------------+
  | [_]  Office Automation              | [_]  CAD/CADAM                      |
  +-------------------------------------+-------------------------------------+
  | [_]  Development Tools              | [_]  Business Specific              |
  +-------------------------------------+-------------------------------------+
  | [_]  Network Management             | [_]  Other                          |
  |                                     |              __________             |
  +-------------------------------------+-------------------------------------+
 
  For which national language versions do you develop or translate?
 
  _____________________________________________________________________________
 
 
  What is the primary operating system or environment you develop under?
 
  +-------------------------------------+-------------------------------------+
  | [_]  OS/2                           | [_]  DOS (IBM, MS, DR)              |
  +-------------------------------------+-------------------------------------+
  | [_]  Windows 3.X                    | [_]  OS/400                         |
  +-------------------------------------+-------------------------------------+
  | [_]  Windows NT                     | [_]  MVS                            |
  +-------------------------------------+-------------------------------------+
  | [_]  UNIX  type?                    | [_]  VM                             |
  |                   __________        |                                     |
  +-------------------------------------+-------------------------------------+
  | [_]  DEC VMS                        | [_]  Other                          |
  |                                     |             __________              |
  +-------------------------------------+-------------------------------------+
 
  In what programming languages do you develop?
 
  +-------------------------------------+-------------------------------------+
  | [_]  C/C++                          | [_]  COBOL                          |
  +-------------------------------------+-------------------------------------+
  | [_]  Pascal                         | [_]  Assembler                      |
  +-------------------------------------+-------------------------------------+
  | [_]  Other                          |                                     |
  |             __________              |                                     |
  +-------------------------------------+-------------------------------------+
 
  What is the primary end user interface you develop for?
 
  +-------------------------------------+-------------------------------------+
  | [_]   OS/2 PM                       | [_]   Windows                       |
  +-------------------------------------+-------------------------------------+
  | [_]   X Windows                     | [_]   MOTIF Openlook                |
  +-------------------------------------+-------------------------------------+
  | [_]   SCO Open Desktop              | [_]   NEXT                          |
  +-------------------------------------+-------------------------------------+
  | [_]   Other                         |                                     |
  |              __________             |                                     |
  +-------------------------------------+-------------------------------------+
 
  What systems do you develop for?
 
  +-------------------------------------+-------------------------------------+
  | [_]   Workstation/PC                | [_]   Mainframe                     |
  +-------------------------------------+-------------------------------------+
  | [_]   Midrange                      | [_]   Other                         |
  |                                     |              __________             |
  +-------------------------------------+-------------------------------------+
 
  Do you have a CD-ROM device?
 
  [_]   No     [_]   Yes:   Brand & Model
                                          ______________________________
 

  If you are planning to buy a CD-ROM drive, what brand and model are you con-
  sidering, and when?
 
  _____________________________________________________________________________
 
  Please tell us about the OS/2 product that you are developing or planning to
  develop.  (Do not include confidential or proprietary information.)
 
  _____________________________________________________________________________
 
  _____________________________________________________________________________
 
  _____________________________________________________________________________
 
  We are collecting this information to better serve developers who are
  accepted into this program.   Return this form by mailing it to the
  Internet address wwdap@vnet.ibm.com or fax it to (407) 443-3241 or
  (407) 998-7610, or send it to:
 
      IBM Developer Assistance Program
      Internal Zip 2230
      PO Box 1328
      Boca Raton, FL 33429-1328
      U.S.A.

  Thank you!