Organization Registration 2019 Lifesaver Wellbeing Series

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* 1. YES! I pledge that our organization is committed to wellbeing and participating in the 2019 Lifesaver Wellbeing Series.

As a Team Champion I will:
* Submit and share "Lifesaver" success stories
* Utilize the free monthly wellbeing resources such as downloadable materials, programs, lunch and learn presentations, wellness challenges and self-directed learning courses.
* Keep my leadership team informed of the activities in which our organization is a part of as well as program results

Yes

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* 2. Name of organization:

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* 3. Approximate number of Local & Regional Employees (Green Bay/De Pere, Northeast WI & Upper MI)

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* 4. Contact Information:

Team Champion Name:

Address:

Address 2:

City/Town:

State:

ZIP:

Email Address:

Phone Number:

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* 5. As part of the registration process, Bellin Health requires health plan group number(s) for your organization. If unable to provide, please let us know who at your organization who can provide that information and a representative from the Bellin Health team will follow-up.

Group #(s) for health plan:

Name:

Email Address:

Phone Number:

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* 6. Please confirm: I have spoken with leadership at my organization and they support our commitment to the 2018 Lifesaver Wellbeing Series.

Yes

Leader's Name

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* 7. Please contact me with more information about how a Wellbeing Activator can help with our wellbeing program implementation.

YES

Comments:

CONGRATULATIONS and THANK YOU for registering. Please visit www.bellin.org/lifesaver to start planning your organization's journey towards improved wellbeing. Nurse Jesse would like to assist you in planning your organization's wellbeing calendar so please contact her at: WellbeingConsultant@bellin.org or call: (920) 436-8668.