election to participate in s2techs section 125 premium only plan

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					                         Election to Sponsor through S2Tech’s Fortune Fund

Date __________


Name:                                         _____


Address:
__________________________________________




I would like to sponsor student(s) through S2Tech’s Fortune Fund.

I am aware that the cost for each student is $30 per year. S2Tech will advise if amounts change.

Number of student(s) sponsoring _____

I understand that:

           I understand this is fully voluntary on my part.
           I hereby elect the above-specified contribution.
           If I change my contribution amount by increasing or decreasing it, I will let S2Tech know
           I will be offered the opportunity to change my benefit elections at any time during the year.


By:                                                                  Date:
               Signature


* Please send this form duly filled and signed to Kim Hobratschk. (kimh@s2tech.com). Fax# 314-754-9839

				
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