Thank you for filling out the form below. The fields marked with (*) are required fields. * Your Organization  * required * First Name  * required * Last Name  * required * Email Address  * required   Address   City   State   Zip Code   Please indicate the number of unions your organization has agreements with 1 2 3 4 5 or more * Please select the entity type that best describes your organization School District BOCES Local / City / State /Government Municipal Authority Other   Approximate number of active employees   Approximate number of retired employees * Do retired employees receive employer subsidized health insurance? Yes No * Do retired employees receive employer subsidized dental insurance after age 65? Yes No * Do retired employees receive employer subsidized life insurance? Yes No   Describe any other benefits that may be provided to retired employees.