Fill in the data required and click the "Print" button of your browser.

Hit the bowser "Back" button when ready.


Please, ship copies the Amedic-3D '98 Rel.1.3 Test Drive CD
* to the address below.
Amedic-3D '98 Rel.1.3 Test Drive CD: x $11.95 = $
Card No.:
Exp. Date:
Signature:  
Name:
Position:
Organization:
Street:
City:
ZIP:
State:
Country:
Phone:
Fax:
Email:

* The CD contains Amedic-3D three month evaluation copy, Amedic-DICOM viewer and sample data


Please, print and send this form, together with a check or money order to:
A1 Alpha Space, Inc., P.O. Box 3657, Laguna Hills, CA 92654, USA