Attachment "B" 

Person Designated as Agency Contact for Information on
2003 Early Retirement Incentive Program Workshops

Agency Name:

Agency Address:

This agency has designated the following staff member to handle reservations for our employees who are eligible for the early retirement incentive program and who wish to attend one of the scheduled workshops.

Designated Contact's Name:

Title:

Telephone Number:

Fax Number:

___________________________
Authorized Agency Signature

___________________________
Title

___________________________
Date

Return to 2003 ERIP memo

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