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EXHIBIT 99.14
THERATX, INCORPORATED
EMPLOYEE STOCK PURCHASE PLAN ("ESPP")
ENROLLMENT/CHANGE FORM
Action Complete Sections:
SECTION 1: / / New Enrollment 2, 3, 7 and sign attached
ACTION Stock Purchase Agreement
/ / Change Payroll Deductions 2, 4, 7
/ / Terminate Payroll Deductions 2, 5, 7
/ / Leave of Absence 2, 6, 7
SECTION 2: Name _____________________________________________________________________________
PERSONNEL Last First MI Dept.
DATA
Home Address _____________________________________________________________________
Street
_____________________________________________________________________________
City State Zip Code
Social Security #: - -
SECTION 3: Effective with the Purchase
NEW Period Beginning: Payroll Deduction Amount: _____% of base salary*
ENROLLMENT / / May 1, 199_
/ / November 1, 199_ * Must be a multiple of 1% up to a maximum of 10%
of base salary, but in no event more than $5,000 per
purchase period
/ / Initial Purchase Period -- November 1, 1996
SECTION 4: Effective with the I authorize the following new level of payroll
CHANGE Pay Period Beginning: ______________________________ deductions: ________% of base salary*
PAYROLL Month, Day and Year
DEDUCTIONS * Must be a multiple of 1% up to a maximum of 10%
of base salary, but in no event more than $5,000 per
purchase period
NOTE: You may reduce your rate of payroll deductions once per purchase period to become effective as
soon as possible following the filing of the change form. You may also increase your rate of
payroll deductions to become effective as of the start date of the next purchase period.
SECTION 5: Effective with the Your election to terminate your payroll deductions for
TERMINATE Pay Period Beginning: ______________________________ the balance of the purchase period cannot be changed,
PAYROLL Month, Day and Year and you may not rejoin that purchase period at a later
DEDUCTIONS date. You will not be able to resume participation in
the ESPP until a new purchase period begins.
I understand that any ESPP payroll deductions which I may have made to date in the current purchase period
will be refunded to me as soon as possible.
NOTE: 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 for that purchase period will automatically be refunded to you.
SECTION 6 In connection with my unpaid leave of absence, I elect the following action regarding any ESPP payroll
LEAVE deductions which I may have made to date in the current purchase period:
OF
ABSENCE
/ / Purchase TheraTx shares 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.
SECTION 7
AUTHORIZATION
I hereby authorize the specific action or actions indicated above.
____________________________________ _____________________________________________
Date Signature of Employee
