Common use of Election to Revoke Participation Clause in Contracts

Election to Revoke Participation. I do not want to participate in the Plan at this time. I understand that I may change this election by completing a new Enrollment Form prior to the next Plan Entry Date. Please discontinue my Salary Deferral Contributions to the Plan. I understand that I will be able to resume participation by completing a new Enrollment Form prior to the next Plan Entry Date. I direct my new money to be invested in the funds selected below. I understand these investment directions will remain in effect until I direct new elections through the Plan’s web site or voice response system. Investment Elections Fund Name Amount to Traditional 403(b) (Per Pay Period) AXA Equitable American Funds - R1 Investments American Funds - R2 Investments American Funds - R3 Investments American Funds - R4 Investments Ameriprise Financial Services Great American Insurance Group Xxxxxx Xxxx Insurance Co. Lincoln Investment Planning MetLife MetLife Insurance Company USA Modern Woodmen of America Investment Elections (Continued) Fund Name Amount to Traditional 403(b) (Per Pay Period) Xxxxxxxxxxx Funds Reliastar Life Insurance Company Security Benefit Vanguard Investments Variable Annuity Life Insurance Company (VALIC) Voya Retirement Insurance and Annuity Company Total By signing this Agreement, Employee agrees to modify his/her salary as indicated above and Employer agrees to contribute this amount on Employee’s behalf into the 403(b) annuity(ies) or custodial account(s) selected by Employee and authorized by the Employer. It is intended that the requirements of all applicable state and federal tax rules and regulations (Applicable Law) will be met. Employee understands and agrees that this Agreement:

Election to Revoke Participation. I do not want to participate in the Plan at this time. I understand that I may change this election by completing a new Enrollment Form prior to the next Plan Entry Date. Please discontinue my Salary Deferral Contributions to the Plan. I understand that I will be able to resume participation by completing a new Enrollment Form prior to the next Plan Entry Date. I direct my new money to be invested in the funds selected below. I understand these investment directions will remain in effect until I direct new elections through the Plan’s web site or voice response system. Investment Elections Fund Name Amount to Traditional 403(b) (Per Pay Period) AXA Equitable American Funds - A Share Investments American Funds - R1 Investments American Funds - R2 Investments American Funds - R3 Investments American Funds - R4 Investments Ameriprise Financial Services Commonwealth Annuity and Life Insurance Co. Fidelity Security Life Insurance Company First Investors Corporation Great American Insurance Group Financial Resources Xxxxxx Xxxx Insurance Co. Lincoln Investment Planning MetLife MetLife Insurance Company USA Modern Woodmen of America Investment Elections (Continued) Fund Name Amount to Traditional 403(b) (Per Pay Period) ING Life and Annuity Company (ILIAC) Industrial Alliance Pacific Life Insurance Co. of the Southwest Lincoln Investment Planning Lincoln National Life Insurance Co. MassMutual Life Insurance MetLife MetLife of Connecticut Midland National Life Insurance Company Modern Woodmen of America North American Co. for Life & Health Insurance Xxxxxxxxxxx Funds Reliastar Life Insurance Company Security Benefit USAA Life Insurance Company Vanguard Investments Variable Annuity Life Insurance Company (VALIC) Voya Retirement Insurance and Annuity Company Total By signing this Agreement, Employee Xxxxxxxx agrees to modify his/her salary as indicated above and Employer agrees to contribute this amount on Employee’s behalf into the 403(b) annuity(ies) or custodial account(s) selected by Employee and authorized by the Employer. It is intended that the requirements of all applicable state and federal tax rules and regulations (Applicable Law) will be met. Employee understands and agrees that this Agreement:

Election to Revoke Participation. I do not want to participate in the Plan at this time. I understand that I may change this election by completing a new Enrollment Form prior to the next Plan Entry Date. Please discontinue my Salary Deferral Contributions to the Plan. I understand that I will be able to resume participation by completing a new Enrollment Form prior to the next Plan Entry Date. I direct my new money to be invested in the funds selected below. I understand these investment directions will remain in effect until I direct new elections through the Plan’s web site or voice response system. Investment Elections Fund Name Amount to Xxxx 403(b) (Per Pay Period) Amount to Traditional 403(b) (Per Pay Period) AXA Equitable American Funds - A Share Investments American Funds - R1 Investments American Funds - R2 Investments American Funds - R3 Investments American Funds - R4 Investments Ameriprise Financial Services Commonwealth Annuity and Life Insurance Co. Fidelity Security Life Insurance Company Great American Insurance Group Financial Resources Xxxxxx Xxxx Insurance Co. Lincoln Investment Planning MetLife MetLife Insurance Company USA Modern Woodmen of America Investment Elections (Continued) Fund Name Amount to Xxxx 403(b) (Per Pay Period) Amount to Traditional 403(b) (Per Pay Period) ING Life and Annuity Company (ILIAC) Industrial Alliance Pacific Life Insurance Co. of the Southwest Lincoln National Life Insurance Co. MassMutual Life Insurance MetLife MetLife of Connecticut Midland National Life Insurance Company Modern Woodmen of America North American Co. for Life & Health Insurance Xxxxxxxxxxx Funds Reliastar Life Insurance Company Security Benefit USAA Life Insurance Company Vanguard Investments Variable Annuity Life Insurance Company (VALIC) Voya Retirement Insurance and Annuity Company Total By signing this Agreement, Employee Xxxxxxxx agrees to modify his/her salary as indicated above and Employer agrees to contribute this amount on Employee’s behalf into the 403(b) annuity(ies) or custodial account(s) selected by Employee and authorized by the Employer. It is intended that the requirements of all applicable state and federal tax rules and regulations (Applicable Law) will be met. Employee understands and agrees that this Agreement:

Election to Revoke Participation. I do not want to participate in the Plan at this time. I understand that I may change this election by completing a new Enrollment Form prior to the next Plan Entry Date. Please discontinue my Salary Deferral Contributions to the Plan. I understand that I will be able to resume participation by completing a new Enrollment Form prior to the next Plan Entry Date. I direct my new money to be invested in the funds selected below. I understand these investment directions will remain in effect until I direct new elections through the Plan’s web site or voice response system. Investment Elections Fund Name Amount to Xxxx 403(b) (Per Pay Period) Amount to Traditional 403(b) (Per Pay Period) AXA Equitable American Funds - R1 Investments American Funds - R2 Investments American Funds - R3 Investments American Funds - R4 Investments Ameriprise Financial Services Great American Insurance Group Financial Resources Xxxxxx Xxxx Insurance Co. ING Life and Annuity Company (ILIAC) Lincoln Investment Planning MetLife MetLife Insurance Company USA Modern Woodmen of America Investment Elections (Continued) Fund Name Amount to Traditional 403(b) (Per Pay Period) Xxxxxxxxxxx Funds Reliastar Symetra Life Insurance Company Security Benefit Vanguard Investments Variable Annuity Life Insurance Company (VALIC) Voya Retirement Insurance and Annuity Company The Legend Group Total By signing this Agreement, Employee Xxxxxxxx agrees to modify his/her salary as indicated above and Employer agrees to contribute this amount on Employee’s behalf into the 403(b) annuity(ies) or custodial account(s) selected by Employee and authorized by the Employer. It is intended that the requirements of all applicable state and federal tax rules and regulations (Applicable Law) will be met. Employee understands and agrees that this Agreement:

Election to Revoke Participation. I do not want to participate in the Plan at this time. I understand that I may change this election by completing a new Enrollment Form prior to the next Plan Entry Date. Please discontinue my Salary Deferral Contributions to the Plan. I understand that I will be able to resume participation by completing a new Enrollment Form prior to the next Plan Entry Date. I direct my new money to be invested in the funds selected below. I understand these investment directions will remain in effect until I direct new elections through the Plan’s web site or voice response system. Investment Elections Fund Name Account Number (Required) Amount to Traditional 403(b) (Per Pay Period) AXA Equitable American Funds - R1 Investments American Funds - R2 Investments American Funds - R3 Investments American Funds - R4 Investments Ameriprise Financial Services Great American Insurance Group Xxxxxx Xxxx Insurance Co. Lincoln Investment Planning MetLife MetLife Insurance Company USA Modern Woodmen of America Investment Elections (Continued) Fund Name Amount to Traditional Xxxx 403(b) (Per Pay Period) Xxxxxxxxxxx American Funds Reliastar - R3 Investments Ameriprise Financial Services ASPire Financial Services Equitable Invesco Ivy Investments Xxxxx-Xxxxxxxx Lincoln Investment Planning MetLife Insurance Company USA (Brighthouse) Midland National Life Insurance Company National Life Group PlanMember Services Primerica Security Benefit Vanguard Investments Variable Annuity Life Insurance Company (VALIC) Voya Retirement Insurance and Annuity Company Total Participant Name Social Security No. By signing this Agreement, Employee Xxxxxxxx agrees to modify his/her salary as indicated above and Employer agrees to contribute this amount on Employee’s behalf into the 403(b) annuity(ies) or custodial account(s) selected by Employee and authorized by the Employer. It is intended that the requirements of all applicable state and federal tax rules and regulations (Applicable Law) will be met. Employee understands and agrees that this Agreement:

Election to Revoke Participation. I do not want to participate in the Plan at this time. I understand that I may change this election by completing a new Enrollment Form prior to the next Plan Entry Date. Please discontinue my Salary Deferral Contributions to the Plan. I understand that I will be able to resume participation by completing a new Enrollment Form prior to the next Plan Entry Date. I direct my new money to be invested in the funds selected below. I understand these investment directions will remain in effect until I direct new elections through the Plan’s web site or voice response system. Investment Elections Fund Name Amount to Xxxx 403(b) (Per Pay Period) Amount to Traditional 403(b) (Per Pay Period) ASPire Financial Services, LLC AXA Equitable American Funds - R1 Investments American Funds - R2 Investments American Funds - R3 Investments American Funds - R4 Investments Ameriprise Financial Services Xxxxxx Xxxxx Great American Insurance Group Xxxxxx Xxxx Insurance Co. Xxxxx-Xxxxxxxx Lincoln Investment Planning MetLife MetLife Insurance Company USA Modern Woodmen of America Midland National Life Insurance Company National Life Group Investment Elections (Continued) Fund Name Amount to Xxxx 403(b) (Per Pay Period) Amount to Traditional 403(b) (Per Pay Period) Xxxxxxxxxxx Funds Reliastar PlanMember Services Primerica Security Benefit Symetra Life Insurance Company Security Benefit Vanguard Investments Variable Annuity Life Insurance Company (VALIC) Voya Retirement Insurance and Annuity Company Xxxxxxx & Xxxx Total By signing this Agreement, Employee agrees to modify his/her salary as indicated above and Employer agrees to contribute this amount on Employee’s behalf into the 403(b) annuity(ies) or custodial account(s) selected by Employee and authorized by the Employer. It is intended that the requirements of all applicable state and federal tax rules and regulations (Applicable Law) will be met. Employee understands and agrees that this Agreement:

Election to Revoke Participation. I do not want to participate in the Plan at this time. I understand that I may change this election by completing a new Enrollment Form prior to the next Plan Entry Date. Please discontinue my Salary Deferral Contributions to the Plan. I understand that I will be able to resume participation by completing a new Enrollment Form prior to the next Plan Entry Date. I direct my new money to be invested in the funds selected below. I understand these investment directions will remain in effect until I direct new elections through the Plan’s web site or voice response system. Investment Elections Fund Name Amount to Traditional Xxxx 403(b) (Per Pay Period) AXA Equitable American Funds - R1 Investments American Funds - R2 Investments American Funds - R3 Investments American Funds - R4 Investments Ameriprise Financial Services Great American Insurance Group Xxxxxx Xxxx Insurance Co. Lincoln Investment Planning MetLife MetLife Insurance Company USA Modern Woodmen of America Investment Elections (Continued) Fund Name Amount to Traditional 403(b) (Per Pay Period) Xxxxxxxxxxx American Funds Reliastar - R3 Investments Ameriprise Financial Services ASPire Financial Services, LLC Equitable Invesco Ivy Funds Xxxxx-Xxxxxxxx Lincoln Investment Planning MetLife MetLife Insurance Company USA Midland National Life Insurance Company Investment Elections (Continued) Fund Name Amount to Xxxx 403(b) (Per Pay Period) Amount to Traditional 403(b) (Per Pay Period) National Life Group PlanMember Services Primerica Security Benefit Vanguard Investments Variable Annuity Symetra Life Insurance Company (VALIC) Voya Retirement Insurance and Annuity Company Total By signing this Agreement, Employee Xxxxxxxx agrees to modify his/her salary as indicated above and Employer agrees to contribute this amount on Employee’s behalf into the 403(b) annuity(ies) or custodial account(s) selected by Employee and authorized by the Employer. It is intended that the requirements of all applicable state and federal tax rules and regulations (Applicable Law) will be met. Employee understands and agrees that this Agreement:

Election to Revoke Participation. I hereby apply for Participation in the above-named 403(b) Plan and direct my employer to withhold through payroll reduction the following amounts from each pay. I understand this election will be applied to future contributions only and will remain in effect until I direct new elections through the Plan’s Internet or Voice Response System. NOTE: I understand that if I am 50 years of age or will reach the age of 50 during this calendar year any contribution deferrals in excess of the traditional salary will be applied to the Age 50 Catch-up option. I do not want to participate in the Plan at this time. I understand that I may change this election by completing a new Enrollment Form prior to the next Plan Entry Date. Please discontinue my Salary Deferral Contributions to the Plan. I understand that I will be able to resume participation by completing a new Enrollment Form prior to the next Plan Entry Date. I direct my new money to be invested in the funds selected below. I understand these investment directions will remain in effect until I direct new elections through the Plan’s web site or voice response system. Investment Elections Fund Name Account Number (Required) Amount to Traditional 403(b) (Per Pay Period) AXA Equitable Amount to Xxxx 403(b) (Per Pay Period) AIG Retirement Services American Funds - R1 Investments American Funds - R2 Investments American Funds - R3 Investments American Funds - R4 Investments Ameriprise Financial Services Great American Insurance Group Equitable Xxxxxx Xxxx Insurance Co. Invesco Xxxxx-Xxxxxxxx Lincoln Financial Group Lincoln Investment Planning MetLife MetLife Insurance Company USA Modern Woodmen of America Investment Elections (ContinuedBrighthouse) Fund Name Amount to Traditional 403(b) (Per Pay Period) Xxxxxxxxxxx Funds Reliastar Midland National Life Insurance Company Security Benefit N/A Vanguard Investments Variable Annuity Life Insurance Company (VALIC) Voya Retirement Insurance and Annuity Company Total By signing this Agreement, Employee Xxxxxxxx agrees to modify his/her salary as indicated above and Employer agrees to contribute this amount on Employee’s behalf into the 403(b) annuity(ies) or custodial account(s) selected by Employee and authorized by the Employer. It is intended that the requirements of all applicable state and federal tax rules and regulations (Applicable Law) will be met. Employee understands and agrees that this Agreement:

Election to Revoke Participation. I do not want to participate in the Plan at this time. I understand that I may change this election by completing a new Enrollment Form prior to the next Plan Entry Date. Please discontinue my Salary Deferral Contributions to the Plan. I understand that I will be able to resume participation by completing a new Enrollment Form prior to the next Plan Entry Date. I direct my new money to be invested in the funds selected below. I understand these investment directions will remain in effect until I direct new elections through the Plan’s web site or voice response system. Investment Elections Fund Name Amount to Xxxx 403(b) (Per Pay Period) Amount to Traditional 403(b) (Per Pay Period) AXA Equitable American Funds - R1 Investments American Funds - R2 Investments American Funds - R3 Investments American Funds - R4 Investments Ameriprise Financial Services Foresters Financial Services, Inc. Great American Insurance Group Xxxxxx Xxxx Insurance Co. Lincoln Investment Planning MetLife MetLife Insurance Company USA Modern Woodmen of America Investment Elections (Continued) Fund Name Amount to Traditional 403(b) (Per Pay Period) Xxxxxxxxxxx Funds Reliastar Life Insurance Company Security Benefit Vanguard Investments Variable Annuity Life Insurance Company (VALIC) Voya Retirement Insurance and Annuity Company Xxxxxxx & Xxxx Total By signing this Agreement, Employee Xxxxxxxx agrees to modify his/her salary as indicated above and Employer agrees to contribute this amount on Employee’s behalf into the 403(b) annuity(ies) or custodial account(s) selected by Employee and authorized by the Employer. It is intended that the requirements of all applicable state and federal tax rules and regulations (Applicable Law) will be met. Employee understands and agrees that this Agreement:

Election to Revoke Participation. I do not want to participate in the Plan at this time. I understand that I may change this election by completing a new Enrollment Form prior to the next Plan Entry Date. Please discontinue my Salary Deferral Contributions to the Plan. I understand that I will be able to resume participation by completing a new Enrollment Form prior to the next Plan Entry Date. I direct my new money to be invested in the funds selected below. I understand these investment directions will remain in effect until I direct new elections through the Plan’s web site or voice response system. Investment Elections Fund Name Amount to Traditional 403(b) (Per Pay Period) AXA Equitable American Funds - R1 Investments American Funds - R2 Investments American Funds - R3 Investments American Funds - R4 Investments Ameriprise Financial Services Federated Funds Franklin Xxxxxxxxx Great American Insurance Group Financial Resources Xxxxxx Xxxx Insurance Co. Industrial Alliance Pacific Jefferson National Life Life Insurance Co. of the Southwest Lincoln Investment Planning National Life Insurance Co. MetLife MetLife Insurance Company USA Modern Woodmen of America Investment Elections (Continued) Fund Name Amount to Traditional 403(b) (Per Pay Period) Xxxxxxxxxxx Funds Reliastar PlanMember Services USAA Life Insurance Company Security Benefit Vanguard Investments Variable Annuity Life Insurance Company (VALIC) Voya Retirement Insurance and Annuity Company Total By signing this Agreement, Employee Xxxxxxxx agrees to modify his/her salary as indicated above and Employer agrees to contribute this amount on Employee’s behalf into the 403(b) annuity(ies) or custodial account(s) selected by Employee and authorized by the Employer. It is intended that the requirements of all applicable state and federal tax rules and regulations (Applicable Law) will be met. Employee understands and agrees that this Agreement:

Election to Revoke Participation. I do not want to participate in the Plan at this time. I understand that I may change this election by completing a new Enrollment Form prior to the next Plan Entry Date. Please discontinue my Salary Deferral Contributions to the Plan. I understand that I will be able to resume participation by completing a new Enrollment Form prior to the next Plan Entry Date. I direct my new money to be invested in the funds selected below. I understand these investment directions will remain in effect until I direct new elections through the Plan’s web site or voice response system. Investment Elections Fund Name Amount to Traditional Xxxx 403(b) (Per Pay Period) AXA Equitable American Funds - R1 Investments American Funds - R2 Investments American Funds - R3 Investments American Funds - R4 Investments Ameriprise Financial Services Great American Insurance Group Xxxxxx Xxxx Insurance Co. Lincoln Investment Planning MetLife MetLife Insurance Company USA Modern Woodmen of America Investment Elections (Continued) Fund Name Amount to Traditional 403(b) (Per Pay Period) Xxxxxxxxxxx Funds Reliastar ASPire Financial Services, LLC AXA Equitable ING Life and Annuity Company (ILIAC) Xxxxx-Xxxxxxxx MetLife MetLife of Connecticut PlanMember Services Security Benefit Symetra Life Insurance Company Security Benefit The Legend Group Vanguard Investments Variable Annuity Life Insurance Company (VALIC) Voya Retirement Insurance and Annuity Company Investment Elections (Continued) Fund Name Amount to Xxxx 403(b) (Per Pay Period) Amount to Traditional 403(b) (Per Pay Period) Xxxxxxx & Xxxx Total By signing this Agreement, Employee Xxxxxxxx agrees to modify his/her salary as indicated above and Employer agrees to contribute this amount on Employee’s behalf into the 403(b) annuity(ies) or custodial account(s) selected by Employee and authorized by the Employer. It is intended that the requirements of all applicable state and federal tax rules and regulations (Applicable Law) will be met. Employee understands and agrees that this Agreement:

Election to Revoke Participation. I do not want to participate in the Plan at this time. I understand that I may change this election by completing a new Enrollment Form prior to the next Plan Entry Date. Please discontinue my Salary Deferral Contributions to the Plan. I understand that I will be able to resume participation by completing a new Enrollment Form prior to the next Plan Entry Date. I direct my new money to be invested in the funds selected below. I understand these investment directions will remain in effect until I direct new elections through the Plan’s web site or voice response system. AXA Equitable Ameriprise Financial Services Foresters Financial Services, Inc. Great American Insurance Group Xxxxxxxxxxx Funds Reliastar Life Insurance Company Security Benefit Voya Retirement Insurance and Annuity Co Variable Annuity Life Insurance Company (VALIC) mpany Xxxxxxx & Xxxx Investment Elections Fund Name Amount to Xxxx 403(b) (Per Pay Period) Amount to Traditional 403(b) (Per Pay Period) AXA Equitable American Funds - R1 Investments American Funds - R2 Investments American Funds - R3 Investments American Funds - R4 Investments AIG Retirement Systems (FKA VALIC) Ameriprise Financial Services Services, Inc. Equitable Holdings (FKA AXA Equitable) Foresters Financial Services, Inc. Great American Insurance Group Xxxxxx Xxxx Insurance Co. Lincoln Investment Planning MetLife MetLife Insurance Company USA Modern Woodmen of America Investment Elections Invesco (ContinuedFKA Xxxxxxxxxxx Funds) Fund Name Amount to Traditional 403(bLPL Financial (FKA Xxxxxxx & Xxxx) (Per Pay Period) Xxxxxxxxxxx Funds Reliastar Life Insurance Company Security Benefit Vanguard Investments Variable Annuity VOYA Retirement (FKA Reliastar, Northern Life Insurance Company (VALICand ING) Voya Retirement Insurance and Annuity Company Total By signing this Agreement, Employee Xxxxxxxx agrees to modify his/her salary as indicated above and Employer agrees to contribute this amount on Employee’s behalf into the 403(b) annuity(ies) or custodial account(s) selected by Employee and authorized by the Employer. It is intended that the requirements of all applicable state and federal tax rules and regulations (Applicable Law) will be met. Employee understands and agrees that this Agreement:

Election to Revoke Participation. I hereby apply for Participation in the above-named 403(b) Plan and direct my employer to withhold through payroll reduction the following amounts from each pay. I understand this election will be applied to future contributions only and will remain in effect until I direct new elections through the Plan’s Internet or Voice Response System. NOTE: I understand that if I am 50 years of age or will reach the age of 50 during this calendar year any contribution deferrals in excess of the traditional salary will be applied to the Age 50 Catch-up option. I do not want to participate in the Plan at this time. I understand that I may change this election by completing a new Enrollment Form prior to the next Plan Entry Date. Please discontinue my Salary Deferral Contributions to the Plan. I understand that I will be able to resume participation by completing a new Enrollment Form prior to the next Plan Entry Date. I direct my new money to be invested in the funds selected below. I understand these investment directions will remain in effect until I direct new elections through the Plan’s web site or voice response system. Investment Elections Fund Name Account Number (Required) Amount to Traditional 403(b) (Per Pay Period) AXA Equitable American Funds - R1 Investments American Funds - R2 Investments American Funds - R3 Investments American Funds - R4 Investments Ameriprise Financial Services Great American Insurance Group ASPire Financial Services Corebridge Financial fka AIG Retirement Services Equitable Xxxxxx Xxxx Insurance Co. Xxxxx-Xxxxxxxx Lincoln Financial Group Lincoln Investment Planning MetLife MetLife Insurance Company USA Modern Woodmen of America Investment Elections (Continued) Fund Name Amount to Traditional 403(b) (Per Pay Period) Xxxxxxxxxxx Funds Reliastar Midland National Life Insurance Company P&A Group PlanMember Services Security Benefit Vanguard Investments Variable Annuity Life Insurance Company (VALIC) Voya Retirement Insurance and Annuity Company Total Participant Name Social Security No. By signing this Agreement, Employee Xxxxxxxx agrees to modify his/her salary as indicated above and Employer agrees to contribute this amount on Employee’s behalf into the 403(b) annuity(ies) or custodial account(s) selected by Employee and authorized by the Employer. It is intended that the requirements of all applicable state and federal tax rules and regulations (Applicable Law) will be met. Employee understands and agrees that this Agreement:

Election to Revoke Participation. I do not want to participate in the Plan at this time. I understand that I may change this election by completing a new Enrollment Form prior to the next Plan Entry Date. Please discontinue my Salary Deferral Contributions to the Plan. I understand that I will be able to resume participation by completing a new Enrollment Form prior to the next Plan Entry Date. I direct my new money to be invested in the funds selected below. I understand these investment directions will remain in effect until I direct new elections through the Plan’s web site or voice response system. Investment Elections Fund Name Amount to Traditional 403(b) (Per Pay Period) AXA Equitable American Funds - R1 Investments American Funds - R2 Investments American Funds - R3 Investments American Funds - R4 Investments Ameriprise Financial Services Commonwealth Annuity and Life Insurance Co. Great American Insurance Group Xxxxxx Xxxx Insurance Co. Xxxxx-Xxxxxxxx Lincoln Investment Planning MetLife MetLife New York Life and Annuity Insurance Company USA Modern Woodmen of America Xxxxxxxxxxx Funds Investment Elections (Continued) Fund Name Amount to Traditional 403(b) (Per Pay Period) Xxxxxxxxxxx Funds Reliastar Life Insurance Company Security Benefit Vanguard Investments Variable Annuity Life Insurance Company (VALIC) Voya Retirement Insurance and Annuity Company Xxxxxxx & Xxxx Total By signing this Agreement, Employee Xxxxxxxx agrees to modify his/her salary as indicated above and Employer agrees to contribute this amount on Employee’s behalf into the 403(b) annuity(ies) or custodial account(s) selected by Employee and authorized by the Employer. It is intended that the requirements of all applicable state and federal tax rules and regulations (Applicable Law) will be met. Employee understands and agrees that this Agreement:

Election to Revoke Participation. I do not want to participate in the Plan at this time. I understand that I may change this election by completing a new Enrollment Form prior to the next Plan Entry Date. Please discontinue my Salary Deferral Contributions to the Plan. I understand that I will be able to resume participation by completing a new Enrollment Form prior to the next Plan Entry Date. I direct my new money to be invested in the funds selected below. I understand these investment directions will remain in effect until I direct new elections through the Plan’s web site or voice response system. Investment Elections Fund Name Account Number (Required) Amount to Traditional 403(b) (Per Pay Period) AXA Equitable American Funds - R1 Investments American Funds - R2 Investments American Funds - R3 Investments American Funds - R4 Investments Ameriprise Financial Services Great American Insurance Group Xxxxxx Xxxx Insurance Co. Lincoln Investment Planning MetLife MetLife Insurance Company USA Modern Woodmen of America Investment Elections (Continued) Fund Name Amount to Traditional Xxxx 403(b) (Per Pay Period) Xxxxxxxxxxx Funds Reliastar Life Insurance Company Ameriprise Financial Services Corebridge Financial fka AIG Retirement Services Equitable Xxxxxx Xxxx Retirement Advantage Invesco Xxxxx-Xxxxxxxx Lincoln Investment Planning MetLife PlanMember Services Security Benefit Vanguard Investments Variable Annuity Life Insurance Company (VALIC) Voya Retirement Insurance and Annuity Company Total By signing this Agreement, Employee Xxxxxxxx agrees to modify his/her salary as indicated above and Employer agrees to contribute this amount on Employee’s behalf into the 403(b) annuity(ies) or custodial account(s) selected by Employee and authorized by the Employer. It is intended that the requirements of all applicable state and federal tax rules and regulations (Applicable Law) will be met. Employee understands and agrees that this Agreement:

Election to Revoke Participation. I do not want to participate in the Plan at this time. I understand that I may change this election by completing a new Enrollment Form prior to the next Plan Entry Date. Please discontinue my Salary Deferral Contributions to the Plan. I understand that I will be able to resume participation by completing a new Enrollment Form prior to the next Plan Entry Date. I direct my new money to be invested in the funds selected below. I understand these investment directions will remain in effect until I direct new elections through the Plan’s web site or voice response system. Investment Elections Fund Name Account Number (Required) Amount to Traditional 403(b) (Per Pay Period) AXA Equitable American Funds - R1 Investments American Funds - R2 Investments American Funds - R3 Investments American Funds - R4 Investments Ameriprise Financial Services Great American Brighthouse Life Insurance Group Co Equitable Xxxxxx Xxxx Insurance Co. Xxxxxx Xxxx Retirement Advantage Invesco Lincoln Investment Planning MetLife MetLife Insurance Company USA Modern Woodmen of America Investment Elections (Continued) Continued on Page 2 Participant Name Social Security No. Fund Name Account Number (Required) Amount to Traditional 403(b) (Per Pay Period) Xxxxxxxxxxx Funds Reliastar MetLife National Life Insurance Company Group New York Life Security Benefit Vanguard Investments Variable Annuity Life Insurance Company (VALIC) Voya Retirement Insurance and Annuity Company Total By signing this Agreement, Employee Xxxxxxxx agrees to modify his/her salary as indicated above and Employer agrees to contribute this amount on Employee’s behalf into the 403(b) annuity(ies) or custodial account(s) selected by Employee and authorized by the Employer. It is intended that the requirements of all applicable state and federal tax rules and regulations (Applicable Law) will be met. Employee understands and agrees that this Agreement:

Election to Revoke Participation. I hereby apply for Participation in the above-named 403(b) Plan and direct my employer to withhold through payroll reduction the following amounts from each pay. I understand this election will be applied to future contributions only and will remain in effect until I direct new elections through the Plan’s Internet or Voice Response System. NOTE: I understand that if I am 50 years of age or will reach the age of 50 during this calendar year any contribution deferrals in excess of the traditional salary will be applied to the Age 50 Catch-up option. I do not want to participate in the Plan at this time. I understand that I may change this election by completing a new Enrollment Form prior to the next Plan Entry Date. Please discontinue my Salary Deferral Contributions to the Plan. I understand that I will be able to resume participation by completing a new Enrollment Form prior to the next Plan Entry Date. I direct my new money to be invested in the funds selected below. I understand these investment directions will remain in effect until I direct new elections through the Plan’s web site or voice response system. Investment Elections Fund Name Account Number (Required) Amount to Traditional 403(b) (Per Pay Period) AXA Equitable Amount to Xxxx 403(b) (Per Pay Period) American Funds - R1 Investments American Funds - R2 Investments American Funds - R3 Investments American Funds - R4 Investments Ameriprise Brighthouse Life Insurance Company Corebridge Financial fka AIG Retirement Services Great American Insurance Group Equitable Xxxxxx Xxxx Insurance Co. Invesco Xxxxx-Xxxxxxxx Lincoln Financial Group Lincoln Investment Planning MetLife MetLife Insurance Company USA Modern Woodmen of America Investment Elections (Continued) Fund Name Amount to Traditional 403(b) (Per Pay Period) Xxxxxxxxxxx Funds Reliastar Midland National Life Insurance Company Security Benefit N/A Vanguard Investments Variable Annuity Life Insurance Company (VALIC) Voya Retirement Insurance and Annuity Company Total By signing this Agreement, Employee Xxxxxxxx agrees to modify his/her salary as indicated above and Employer agrees to contribute this amount on Employee’s behalf into the 403(b) annuity(ies) or custodial account(s) selected by Employee and authorized by the Employer. It is intended that the requirements of all applicable state and federal tax rules and regulations (Applicable Law) will be met. Employee understands and agrees that this Agreement:

Election to Revoke Participation. I do not want to participate in the Plan at this time. I understand that I may change this election by completing a new Enrollment Form prior to the next Plan Entry Date. Please discontinue my Salary Deferral Contributions to the Plan. I understand that I will be able to resume participation by completing a new Enrollment Form prior to the next Plan Entry Date. I direct my new money to be invested in the funds selected below. I understand these investment directions will remain in effect until I direct new elections through the Plan’s web site website or voice response system. Investment Elections Fund Name Account Number REQUIRED Amount to Traditional 403(b) (Per Pay Period) AXA Equitable American Funds - R1 Investments American Funds - R2 Investments American Funds - R3 Investments American Funds - R4 Investments Ameriprise Financial Services Great American Insurance Group Xxxxxx Xxxx Insurance Co. Lincoln Investment Planning MetLife MetLife Insurance Company USA Modern Woodmen of America Investment Elections (Continued) Fund Name Amount to Traditional Xxxx 403(b) (Per Pay Period) Xxxxxxxxxxx Funds Ameriprise Financial Services Corebridge Financial fka AIG Retirement Services Equitable Fiduciary Trust Company of New Hampshire Invesco MG Trust - Penselect Reliastar Life Insurance Company Security Benefit Vanguard Investments Variable Annuity Life Insurance Company (VALIC) Voya Retirement Insurance and Annuity Company Total By signing this Agreement, Employee Xxxxxxxx agrees to modify his/her salary as indicated above and Employer agrees to contribute this amount on Employee’s behalf into the 403(b) annuity(ies) or custodial account(s) selected by Employee and authorized by the Employer. It is intended that the requirements of all applicable state and federal tax rules and regulations (Applicable Law) will be met. Employee understands and agrees that this Agreement:

Election to Revoke Participation. I do not want to participate in the Plan at this time. I understand that I may change this election by completing a new Enrollment Form prior to the next Plan Entry Date. Please discontinue my Salary Deferral Contributions to the Plan. I understand that I will be able to resume participation by completing a new Enrollment Form prior to the next Plan Entry Date. I direct my new money to be invested in the funds selected below. I understand these investment directions will remain in effect until I direct new elections through the Plan’s web site or voice response system. Investment Elections Fund Name Amount to Traditional 403(b) (Per Pay Period) AXA Equitable American Funds - R1 Investments American Funds - R2 Investments American Funds - R3 Investments American Funds - R4 Investments Ameriprise Financial Services Commonwealth Annuity and Life Insurance Co. Great American Insurance Group Xxxxxx Xxxx Insurance Co. Lincoln Investment Planning MassMutual Life Insurance MetLife MetLife Insurance Company USA Modern Woodmen of America Xxxxxxxxxxx Funds Security Benefit Investment Elections (Continued) Fund Name Amount to Traditional 403(b) (Per Pay Period) Xxxxxxxxxxx Funds Reliastar Life Insurance Company Security Benefit Vanguard Investments Variable Annuity Life Insurance Company (VALIC) Voya Retirement Insurance and Annuity Company Xxxxxxx & Xxxx Total By signing this Agreement, Employee Xxxxxxxx agrees to modify his/her salary as indicated above and Employer agrees to contribute this amount on Employee’s behalf into the 403(b) annuity(ies) or custodial account(s) selected by Employee and authorized by the Employer. It is intended that the requirements of all applicable state and federal tax rules and regulations (Applicable Law) will be met. Employee understands and agrees that this Agreement:

Election to Revoke Participation. I do not want to participate in the Plan at this time. I understand that I may change this election by completing a new Enrollment Form prior to the next Plan Entry Date. Please discontinue my Salary Deferral Contributions to the Plan. I understand that I will be able to resume participation by completing a new Enrollment Form prior to the next Plan Entry Date. I direct my new money to be invested in the funds selected below. I understand these investment directions will remain in effect until I direct new elections through the Plan’s web site or voice response system. Investment Elections Fund Name Amount to Traditional 403(b) (Per Pay Period) AXA Equitable American Funds - R1 Investments American Funds - R2 Investments American Funds - R3 Investments American Funds - R4 Investments Ameriprise Financial Services Great American Insurance Group Xxxxxx Xxxx Insurance Co. Xxxxx-Xxxxxxxx Lincoln Investment Planning MetLife MetLife Insurance Company USA Modern Woodmen of America Participant Fees PlanMember Services Security Benefit Investment Elections (Continued) Fund Name Amount to Traditional 403(b) (Per Pay Period) Xxxxxxxxxxx Funds Reliastar Symetra Life Insurance Company Security Benefit Vanguard Investments Variable Annuity Life Insurance Company (VALIC) Voya Retirement Insurance and Annuity Company Total By signing this Agreement, Employee agrees to modify his/her salary as indicated above and Employer agrees to contribute this amount on Employee’s behalf into the 403(b) annuity(ies) or custodial account(s) selected by Employee and authorized by the Employer. It is intended that the requirements of all applicable state and federal tax rules and regulations (Applicable Law) will be met. Employee understands and agrees that this Agreement:

Election to Revoke Participation. I do not want to participate in the Plan at this time. I understand that I may change this election by completing a new Enrollment Form prior to the next Plan Entry Date. Please discontinue my Salary Deferral Contributions to the Plan. I understand that I will be able to resume participation by completing a new Enrollment Form prior to the next Plan Entry Date. I direct my new money to be invested in the funds selected below. I understand these investment directions will remain in effect until I direct new elections through the Plan’s web site or voice response system. Investment Elections Fund Name Amount to Traditional Xxxx 403(b) (Per Pay Period) AXA Equitable American Funds - R1 Investments American Funds - R2 Investments American Funds - R3 Investments American Funds - R4 Investments Ameriprise Financial Services Great American Insurance Group Xxxxxx Xxxx Insurance Co. Lincoln Investment Planning MetLife MetLife Insurance Company USA Modern Woodmen of America Investment Elections (Continued) Fund Name Amount to Traditional 403(b) (Per Pay Period) Xxxxxxxxxxx ASPire Financial Services, LLC AXA Equitable American Funds Reliastar - R4 Investments Ameriprise Financial Services Commonwealth Annuity and Life Insurance Co. Great American Insurance Group Xxxxxx Xxxx Insurance Co. Xxxxx-Xxxxxxxx Lincoln Investment Planning Lincoln National Life Insurance Co. MetLife MetLife Insurance Company USA Investment Elections (Continued) Fund Name Amount to Xxxx 403(b) (Per Pay Period) Amount to Traditional 403(b) (Per Pay Period) PlanMember Services Security Benefit Vanguard Investments Variable Annuity Life Insurance Company (VALIC) Voya Retirement Insurance and Annuity Company Total By signing this Agreement, Employee Xxxxxxxx agrees to modify his/her salary as indicated above and Employer agrees to contribute this amount on Employee’s behalf into the 403(b) annuity(ies) or custodial account(s) selected by Employee and authorized by the Employer. It is intended that the requirements of all applicable state and federal tax rules and regulations (Applicable Law) will be met. Employee understands and agrees that this Agreement:

Election to Revoke Participation. I do not want to participate in the Plan at this time. I understand that I may change this election by completing a new Enrollment Form prior to the next Plan Entry Date. Please discontinue my Salary Deferral Contributions to the Plan. I understand that I will be able to resume participation by completing a new Enrollment Form prior to the next Plan Entry Date. I direct my new money to be invested in the funds selected below. I understand these investment directions will remain in effect until I direct new elections through the Plan’s web site or voice response system. Investment Elections Fund Name Amount to Traditional 403(b) (Per Pay Period) AXA Equitable American Funds - R1 Investments American Funds - R2 Investments American Funds - R3 Investments American Funds - R4 Investments Ameriprise Financial Services Great American Insurance Group Xxxxxx Xxxx Insurance Co. Lincoln Investment Planning MetLife MetLife Insurance Company USA Modern Woodmen of America Xxxxxxxxxxx Funds Investment Elections (Continued) Fund Name Amount to Traditional 403(b) (Per Pay Period) Xxxxxxxxxxx Funds Reliastar Life Insurance Company Security Benefit Vanguard Investments Variable Annuity Life Insurance Company (VALIC) Voya Retirement Insurance and Annuity Company Total By signing this Agreement, Employee agrees to modify his/her salary as indicated above and Employer agrees to contribute this amount on Employee’s behalf into the 403(b) annuity(ies) or custodial account(s) selected by Employee and authorized by the Employer. It is intended that the requirements of all applicable state and federal tax rules and regulations (Applicable Law) will be met. Employee understands and agrees that this Agreement:

Election to Revoke Participation. I do not want to participate in the Plan at this time. I understand that I may change this election by completing a new Enrollment Form prior to the next Plan Entry Date. Please discontinue my Salary Deferral Contributions to the Plan. I understand that I will be able to resume participation by completing a new Enrollment Form prior to the next Plan Entry Date. I direct my new money to be invested in the funds selected below. I understand these investment directions will remain in effect until I direct new elections through the Plan’s web site or voice response system. Investment Elections Fund Name Amount to Xxxx 403(b) (Per Pay Period) Amount to Traditional 403(b) (Per Pay Period) AXA Equitable American Funds - R1 Investments American Funds - R2 Investments American Funds - R3 Investments American Funds - R4 Investments Ameriprise Financial Services Great American Insurance Group Xxxxxx Xxxx Insurance Co. Xxxx'x Retirement Advantage Xxxxx-Xxxxxxxx Lincoln Investment Planning MetLife MetLife Lincoln National Life Insurance Company USA Modern Woodmen of America Investment Elections (Continued) Fund Name Amount to Traditional 403(b) (Per Pay Period) Xxxxxxxxxxx Funds Reliastar Co. North American Co. for Life & Health Insurance Security Benefit USAA Life Insurance Company Security Benefit Vanguard Investments Variable Annuity Life Insurance Company (VALIC) Voya Retirement Insurance and Annuity Company Total By signing this Agreement, Employee Xxxxxxxx agrees to modify his/her salary as indicated above and Employer agrees to contribute this amount on Employee’s behalf into the 403(b) annuity(ies) or custodial account(s) selected by Employee and authorized by the Employer. It is intended that the requirements of all applicable state and federal tax rules and regulations (Applicable Law) will be met. Employee understands and agrees that this Agreement: