Beneficiary Designation Form

I hereby make the following designation of beneficiary for my retirement plan account:

Primary:           Name (s)                                  Relationship
                                                                                                                                                
                                                                                                                                                
Contingent:      Name (s)                                    Relationship
                                                                                                                                                
                                                                                                                                                

If more than one beneficiary is designated, any benefits payable will be shared equally among all survivors unless otherwise provided herein. Any beneficiary designations previously made by me are hereby revoked.

Employee's Signature ___________________________________________

Spousal Consent (complete this section only if you are not naming your spouse as beneficiary)

I am the spouse of the participant named on this form, and I waive my right to the designation of beneficiary set forth above. by not being named above as beneficiary, I will receive no benefit from this Plan.

Spouse's Signature                                                                                                                                                                                                       (Your spouse's signature must be notarized)

Date