david/daniel, please remove this paragraph when you build the page.

we need a database built that can be linked to the master KANSAS GAS

database or any of the employees in our clients that will allow emps to

signup for this program and store the fact they are users and have signed up

and award them 10 points for doing it. I will get the TERMS of USE doc done

and link to this page asap

Company

Name

Phone

address

email

city/state/zip

last 4 digits of emp id number

last 4 digits of social security number

last 2 digits of birth date

I have READ and AGREE to the TERMS of USAGE

as provided in 4minuteTerms.pdf attached.

___ACCEPT & Submit Signup Application