Request Printed 2005 Reporting & Disclosure Calendar
for Benefit Plans

First Name
Last Name
Your Title
Your Organization
Address
City
State
Zip Code
Your e-mail Address
Your Phone Number
Your Comments	I would like to request a poster-size publication of the 2005 Reporting & Disclosure Calendar for Benefit Plans. Thank you.
The Segal Company is considering creating an electronic mailing list to inform clients and other friends about developments in the benefits field. Would you like us to add your E-mail address to this list? We will also add your name and address to our mailing list for printed publications. YES NO
The information you provide will not be shared with anyone outside The Segal Company.