AssistiveWare - Register Your AssistiveWare Software

Please use this form to register a copy of KeyStrokes, SwitchXS, Proloquo, LayoutKitchen, Infovox iVox, VisioVoice or TouchStrokes that you already purchased with your dealer, local distributor or with us.

Required fields are colored red and marked with an asterisk.

A note about privacy: The information supplied in this form will be used to further improve our products and services. Your personal information will not be made available to third parties unless you specifically request so.

* Your Name:
* Your e-mail address:	(watch out for typos: we need this to reply to you)
Your company or organization:
* Select a product:
* Version you currently use:
* Your serial number or activation code:	(look in the Activation window of the product)
* Your country of residence:
* Preferred language:
	(indicate which language you would prefer to communicate in)
Interest:
	(indicate whether your interest is personal or professional)
Processor type of your computer:
System software version you use:
Reason why you use the product:	Other:
Any special hardware you use the product with:	Other:
How did you find out about the product?
Which assistive technology software by other manufacturers have you used?

	Are you willing to participate in an occasional product improvement survey? Yes No
	Should the information in this form be shared with the local distributor in your region? Yes No
Any comments:

AssistiveWare and ConvenienceWare are trade names of AssistiveWare B.V. and trademarks or registered trademarks of Niemeijer Consult. Proloquo, Proloquo2Go, KeyStrokes, TouchStrokes, SwitchXS, LayoutKitchen, Dwellix, PolyPredix, VisioVoice, GhostReader, SmartTransparency and the salamander logo are trademarks or registered trademarks of Niemeijer Consult. Infovox iVox is a trademark of Acapela Group. HeadMouse is a registered trademark of Origin Instruments. Macintosh, Power Macintosh and Mac are trademarks of Apple Computer, Inc., registered in the U.S. and other countries. All other trademarks and registered trademarks are the property of their respective owners.