Exhibit (a)(1)(D)
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STOCK OPTION EXCHANGE PROGRAM
ELECTION FORM / NOTICE OF WITHDRAWAL / CHANGE OF ELECTION FORM
ELECTION FORM / NOTICE OF WITHDRAWAL / CHANGE OF ELECTION FORM
OFFER TO EXCHANGE CERTAIN OUTSTANDING STOCK OPTIONS FOR NEW STOCK OPTIONS DATED OCTOBER [__], 2009
IMPORTANT: For each of your outstanding eligible options on this document, please fill in the
bubble next to “Exchange” if you wish to exchange the option grant, or fill in the bubble next to
“Do Not Exchange” if you do not wish to exchange the option grant and instead wish to retain the
option with its current terms. If you do not check either “Exchange” or “Do Not Exchange,” we will
interpret this as an election not to exchange the option grant.
| Election | Eligible Option | ||||||||||||||
| Grant ID | Type | Grant Date | Exercise Price | # of Shares Subject to | |||||||||||
| Eligible Option | |||||||||||||||
Exchange o |
Do Not Exchange o |
XXXXXXXXXXX | XXXXXX | YYYYDDMM | $XXXXX.XX | XXXXXXXX | |||||||||
Exchange o |
Do Not Exchange o |
XXXXXXXXXXX | XXXXXX | YYYYDDMM | $XXXXX.XX | XXXXXXXX | |||||||||
Exchange o |
Do Not Exchange o |
XXXXXXXXXXX | XXXXXX | YYYYDDMM | $XXXXX.XX | XXXXXXXX | |||||||||
Exchange o |
Do Not Exchange o |
XXXXXXXXXXX | XXXXXX | YYYYDDMM | $XXXXX.XX | XXXXXXXX | |||||||||
Additional grants may be listed on the reverse side. Please be sure to complete your election request for each grant.
| Signature 1 - Please keep signature within the box. | Date (mm/dd/yyy) |
Daytime Telephone Number | ||
| / / |
| n | C O Y C | 1 1 7 U E F | F I R S T N A M E | L A S T N A M E | + |
013IFF