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5. " � ' v Your Nationwide PEHP is governed by an Advisory C��mmittee comprised of <br /> one plan sponsor representative and one eligible employee representative. Ali <br /> changes to the Plan, except those req�ired by law, must be approved by the <br /> Advisory Committee. <br /> This page is a legal document and part of your Nationwide PEHP contract.The <br /> undersigned has read this document and fully understands its binding effect. <br /> 1. Please sign and photocopy this form. <br /> 2. Retain one copy for your files. <br /> 3. Return the original copy with your PEHP contract. <br /> City of Decatur �(�ZL� �ULL �v� <br /> Employer me lea print Nationwide representative (please print) <br /> . . t <br /> Signat e Si nature <br /> April 6, 2009 �p/���"/ <br /> Date Date <br /> N RI-0209A0-0408 <br /> OO 2008, Nationwide Retirement Solulions. N��I O�W I��� <br /> Nationwide,the Nationwide Framemark, On Your Side <br /> and PEHP are federally registered service marks of On Your Sid e <br /> Nationwide Mutual Insurance Company. <br />