Exhibit 99.3
CELL THERAPEUTICS, INC.
1996 EMPLOYEE STOCK PURCHASE PLAN ("ESPP")
ENROLLMENT/CHANGE FORM
Action Complete Sections:
------ ------------------
SECTION 1: [_] New Enrollment 2, 3, 6, 7 and sign attached
---
ACTIONS Stock Purchase Agreement
[_] Payroll Deduction Change 2, 4, 7
[_] Terminate Payroll Deductions 2, 5, 7
[_] Beneficiary Change 2, 6, 7
[_] Leave of Absence 2, 6, 7
================================================================================
SECTION 2:
Name _________________________________________________________
PERSONNEL Last First MI Dept.
DATA
Home or Mailing Address ______________________________________
Street
___________________________________________________________
City State Zip Code
Social Security #: [_][_][_]-[_][_]-[_][_][_][_]
================================================================================
SECTION 3: Effective with the Offering
Period Beginning: Payroll Deduction Amount: _____% of total base salary.*
NEW [_] January 1, 199___
ENROLLMENT [_] July 1, 199___ * Must be a multiple of 1% up to a maximum of 10% of
base salary
[_] Initial Offering Period -- December 1, 1997
====================================================================================================================================
SECTION 4: Effective with the Offering I authorize the following new level of payroll
Period Beginning: deductions: _____% of base salary*
CHANGE [_] January 1, 199___
PAYROLL [_] July 1, 199___ * Must be a multiple of 1% up to a maximum of 10% of
DEDUCTIONS base salary
NOTE: You may change your rate of payroll deductions to become effective as of the start date of the next offering
---- period by filing the change form at least one (1) business day prior to the start date of such offering
period.
====================================================================================================================================
SECTION 5: Effective with the Your election to terminate your payroll deductions for the
Pay Period Beginning: _______________________ balance of the offering period must be received by the Human
TERMINATE Month, Day and Year Resources Dept. at least one (1) business day prior to the applicable
PAYROLL purchase date, and you may not rejoin that offering period at a later
DEDUCTIONS date. You will not be able to resume participation in the ESPP until
a new offering period begins.
NOTE: In connection with your voluntary termination of payroll
---- deductions, your ESPP payroll deductions collected to date in the
current offering period will be refunded to you as soon as
practicable following the filing of your withdrawal form. In
addition, if your employment terminates for any reason or your
eligibility status changes ((less than)20 hrs/wk or
(less than)5 months/yr), you will immediately cease to
participate in the ESPP, and your ESPP payroll deductions
collected in that offering period will automatically be refunded
to you.
================================================================================
SECTION 6: In connection with my leave of absence, I elect the following
action with respect to my ESPP payroll deductions to date:
LEAVE OF
ABSENCE in the current offering period:
[_] Purchase shares of Cell Therapeutics, Inc. at end of the
period
OR
[_] Refund ESPP payroll deductions collected
NOTE: If you take an unpaid leave of absence, your payroll deductions
---- will immediately cease. Upon your return to active service, your
payroll deductions will automatically resume at the rate in
effect for you at the time you went on leave, provided you are
still an eligible employee under the Plan.
================================================================================
SECTION 7: Beneficiary(ies) Relationship of Beneficiary(ies)
---------------- --------------------------------
BENEFICIARY
_______________________________ ________________________________
_______________________________ ________________________________
================================================================================
SECTION 8:
AUTHORIZATION
I understand my certificate will be issued in street name and delivered to the
brokerage account designated by Cell Therapeutics, Inc.
__________________ ___________________________________
Date Signature of Employee
