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• <br />• <br />B. What I am Not Releasing <br />I am not releasing any claims for post termination benefits, such as retirement benefits, <br />under the provisions of any employee benefit plan. I also am not waiving any rights <br />have with regard to events that occur after the date of this Release. I am also not <br />waiving or releasing workers compensation benefits with the exception of claims under <br />Minnesota Statute 176.82. <br />C. If I Want to Rescind this Participation Agreement and Release <br />I understand that I have fifteen (15) calendar days from the day I sign this Participation <br />Agreement and Release in which to change my mind and rescind it. In order for this <br />rescission to be effective, it must be in writing and delivered to Dan Tesch, Director of <br />Administration, within fifteen (15) days from the date I sign this agreement. I understand <br />that my delivery of a written rescission can be either by hand by 4:00 p.m. on the last <br />day or by certified mail retum receipt requested, postmarked by the last day. <br />/ 2009 <br />Employee Signature Date Signed <br />Witness* <br />* Witness signature does not need to be notarized <br />EMPLOYEE — Once signed and dated: <br />• Make TWO COPIES of this form <br />• Keep one copy for your records <br />• Give one copy to your supervisor <br />• Submit the original to: Dan Tesch, Director of Administration <br />