I've worked with Access and iMIS at past organizations, and they were horrible. 3 years ago, my organization switched to Salesforce, and it has changed our work environment. We have a on-staff developer who customized many fields within Salesforce, including business listings. We use ExactTarget for email marketing. We use EchoSign for electronic invoicing and tracking when someone opens and views a renewal invoice. We also use ShoreTel Sky phone integration to track calls from members and calls made (retention) to members.