Directory Renewal Form

3 EASY WAYS TO RENEW YOUR LISTING…

● Print and Fax this completed form to: (508) 540-8304 or Mail this completed form, with payment to: SEAK, Inc. P.O. Box 729 Falmouth, MA 02541

● Renew by Phone (508) 457-5150

● Renew Online

Reaching over 30,000 Key IME Referral Sources

● SEAK's National Directory of Independent Medical Examiners is the professional and cost effective way to continue receiving new IME referrals and to expand your IME practice.

● Your renewal includes a detailed listing in the next edition of the SEAK IME Print Directory, which is sent to over 30,000 Key IME Referral Sources including: Insurance Companies, IME Companies, Claims Managers, Adjusters, Case Managers, Self-Insureds, Large Employers, Third Party Administrators, Workers Compensation Attorneys, Legal Nurse Consultants and Peer Review Companies.

● Your renewal also includes a full page listing on our website, which averages over 2-million hits per year.

● Your satisfaction is guaranteed. If at any time before August 1, 2009 you are not completely satisfied, you may request and receive a full refund of your renewal fee.

Please continue my Directory listing for: (choose one)

o Next Directory.......... $495

o Next 2 Directories..... $895 (A $95 Savings)

o Next 3 Directories..... $1195 (A $290 Savings)

____ Please charge the listing fee to my: (Circle one) Visa / MasterCard / AMEX Or

____ Check enclosed payable to SEAK, Inc.

Doctor's Name: _________________________________________

Credit Card #_____________________________________________ Exp. Date ______/______

Name on Card___________________________________ Signature_____________________

* Please review your listing on our website. If there are any revisions that you would like to make, please print out your listing from our website and fax the corrections to (508) 540-8304 or call (508) 457-5150.