ADA Analyzer!                           Registration Form

This form is for registering directly with the author. 

The ADA Analyzer!  is not free. It is copyright 1992 and is distributed
as shareware. You may use it to evaluate its suitability to your needs.

If you continue to use the ADA Analyzer! beyond a reasonable evaluation
period, you must register it. 

PLEASE PRINT CLEARLY:

        Name:           ___________________________________

        Address:        ___________________________________

                        ___________________________________

        City, State     ___________________________________

        ZIP Code        ___________________________________



INDICATE ITEMS AND QUANTITY ORDERED:
                                               QUANTITY   TOTAL

        ADA Analyzer Single User Registration     ____    ______
         $195.00 for US mailing addresses
         You will receive a copy of the latest 
         version plus an ADA Analyzer! Manual.

        Shipping & Handling (UPS Ground)                   $6.00

        Total                                              ======

DISK FORMAT:

        The Analyzer! is supplied in either 3.5" or 5.25".
        Please indicate your preference:

                3.5" ______             5.25"______

PAYMENT:

        Please enclose your payment in full and mail to:

                      ADA Positin Analyzer!
              Grandview Occupational Health Services
                       3410 Futures Drive
                   South Sioux City, NE  68776