2009 SPBA Member Directory

Order Form

Date  ________________          

Send Directory to:

Name  _______________________________________________________________________              

Company Name  ________________________________________________________________                    

Address  _____________________________________________________________________                    

City  ___________________________________   State __________      Zip _______________          

SPBA 2009 Directory of Third Party Administration Employee Benefits

Firms and Stop Loss Service Partners                                                         $495.00

(SPBA's strict independent audit process requires that this form be accompanied with a check. To use a credit card, use our online form instead.)

We send the directory to you via priority mail as soon as we receive your check.

Please send this form and your payment to

SPBA

Two Wisconsin Circle, Ste. 670

Chevy Chase, MD  20815

Questions:  Call 301-718-7722 or email spba@erols.com