ISA Instrument Wizard

Individual Renewable Membership: 1 User with 1 Login/Password
$15 Monthly
$100 Annually (save $80)

Institutional Site License Renewable Membership: 1 Site License = 5 Users with Logins/Passwords

	Each Site License for 5 Users-
	$50 Monthly
	$400 Annually (save $200)

	You may choose up to 4 Site Licenses.

First, tell us a bit about yourself:


Name/Address Information Note: * are required fields.
*First Name:
*Last Name:
*Address:


*City, State:
*Zip:
*Phone:
Fax:
*E-Mail:

License Information Please select the number of licenses you wish to purchase..


	Which category best describes you? (check all that apply) Behavioral/Mental Health Professional Health Care Professional Workplace/Human Resource Professional Drug Free Workplace Professional EAP Provider Criminal Justice Personnel School Based Educator/Counselor/Support Team Substance Abuse Prevention or Treatment Practitioner Researcher/Program Evaluator Other: Please specify
	Which category best describes your work setting? University/College Private Sector Public/Government Community-Based Program Schools (Elementary, Middle, or High School) Hospital/Primary Health Care Setting Managed Care Provider Law/Legal Setting Other: Please specify
	In which tools are you most interested? (check all that apply) Screening Diagnostic Research/Evaluation Needs Assessment
	Do you plan to use the instrument(s) for clinical or non-clinical purposes? Clinical Non-Clinical Both
Click CONTINUE to review your information and choose your Login Name(s) & Password(s).