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07-28-09 Item 10f/ .INSURANCE WORKSHOP JULY 14, 2.009 Please select an insurance carrier for FY 2009 -2010. Renewal A vMed (Renewal) Aetna Cigna Humana - Neighborhood Health Partnership United Health Care Vista CO cc) I nUIII Employee Print Name 0O' U q U • INCORPORATED 1927 C p �ZO INSURANCE WORKSHOP JULY 14, 2009 Please select an insurance carrier for FY 2009 -2010. AvMed (Renewal) V Aetna Cigna Humana Neighborhood Health Partnership United Health Care Vista Employee Print Name Employee Signature INSURANCE WORKSHOP JULY 14, 2009 Please select an insurance carrier for FY 2009 -2010. AvMed (Renewal) Aetna Cigna Humana Neighborhood Health Partnership United Health Care Vista V/-C- C-) Employee Print Name Employee Signature INSURANCE WORKSHOP JULY 14, 2.009 Please select an insurance carrier for FY 2009 -2010. AvMed (Renewal) Aetna Cigna Humana Neighborhood Health Partnership United Health Care Vista Employee Print Name ,ra Employee Signature INSURANCE WORKSHOP JULY 14, 2.00 Please select an insurance carrier for FY 2009 -2010. f/ AvMed (Renewal) Aetna Cigna Humana Neighborhood Health Partnership United Health Care Vista l.� • (:- Employee Print Name Employee Signature 1 sour '�. 7 INCORPORATED 1927 �c 0 Rt'Q INSURANCE WORKSHOP JULY 14, 2.009 Please select an insurance carrier for FY 2009 -2010. " AvM ed (Renewal) Aetna Cigna Humana Neighborhood Health Partnership United Health Care Vista Employee Print Name 4Em 41oe Sig nature INSURANCE 'ORKSHOP JULY 14, 2.009 Please select an insurance carrier for FY 2009 -2010. AvMed (Renewal) Aetna Cigna Humana Neighborhood Health Partnership United Health Care Vista Employee Print Name Employee 5 g at INSURANCE WORKSHOP JULY 14, 2.009 Please select an insurance carrier for FY 2009 -2010. AvMed (Renewal) ►� Aetna Cigna Humana Neighborhood Health Partnership United Health Care Vista Employee Print Name Employee Signature � soury� r INCORPORATED • 1927 �ZOIt-ID INSURANCE WORKSHOP JULY 14, 2.009 Please select an insurance carrier for FY 2009 -2010. AvMed (Renewal) Aetna Cigna Humana Neighborhood Health Partnership United Health Care Vista Employee Print Na Employe Signature SOUT�at O� `tr f .5., y U INCORPORATED 1927 P �t O Rte INSURANCE WORKSHOP JULY 17, 2009 Which option from the AvMed (Renewal) are you recommending for FY 2009 -2010? 1. AvMed Renewal (3 — Tier) 2. AvMed (2 — Tier) NLO801U171 Employee Print Name � sour�� r F• 'Y U INCORPORATED • 1927 INSURANCE WORKSHOP JULY 17, 2009 Which option from the AvMed (Renewal) are you recommending for FY 2009 -2010? 1. AvMed Renewal (3 — Tier) 2. AvMed (2 —Tier) Employee Print Name Employee Signature OUT '�• 7 fr 11U n • imroRPORATED 1927_,,- P � RY� INSURANCE WORKSHOP JULY 17, 2009 Which option from the AvMed (Renewal) are you recommending for FY 2009 -2010? 1. AvMed Renewal (3 — Tier) 2. AvMed (2 =Tier) Employee Print Name C--, i 4mployee Signature INSURANCE WORKSHOP JULY 17, 2009 Which option from the AvMed (Renewal) are you recommending for FY 2009 -2010? 1. AvMed Renewal (3 — Tier) 2. AvMed (2 —Tier) Employee Print Name Employee Signature INSURANCE WORKSHOP JULY 17, 2009 Which option from the AvMed (Renewal) are you recommending for FY 2009 - 2010? 1. AvMed Renewal (3 — Tier) 2. AvMed (2 —Tier) Employee Print Name M Sour Ita1,_v":r9 4 O INSURANCE WORKSHOP JULY I 2009 Which option from the AvMed (Renewal) are you recommending for FY 2009 -2010? 1. AvMed Renewal (3 — Tier) 2. AvMed (2 —Tier) ��aqc - C Employee Print Name i Employe& Signature INSURANCE WORKSHOP JULY 17, 2009 Which option from the AvMed (Renewal) are you recommending for FY 2009 - 2010? 1. AvMed Renewal (3 — Tier) 2. AvMed (2 —Tier) A. eeG�eZ Employee Print Name Employee Si re I INSURANCE WORKSHOP JULY 17, 2009 Which option from the AvMed (Renewal) are you recommending for FY 2009 -2010? 1. AvMed Renewal (3 — Tier) 2. _ AvMed (2 —Tier) Employee Print Name V/ c� Employee Signature INSURANCE WORKSHOP JULY 17, 2009 Which option from the AvMed (Renewal) are you recommending for FY 2009 -2010? 1. AvMed Renewal (3 — Tier) I AvMed (2 —Tier) VI Wj 1� �s Employee Print Naide - Employ Signature