Organization Registration 2017 Lifesaver Wellbeing Series

Register online at: https://s.zoomerang.com/r/Org2017LifesaverReg

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* 1. YES! I pledge that our organization is committed to wellbeing and participating in the 2017 Lifesaver Wellbeing Series.

As a Team Champion I will:
* Advocate for participation in wellbeing activities
* Promote completion of the individual pledge and wellbeing survey
* Submit and share "Lifesaver" success stories
* Utilize the free monthly wellbeing resources such as downloadable materials, programs, lunch and learn presentations and self-directed learning courses
* I will record success outcomes and share them with Nurse Jesse to spread good ideas and "bright spots"
* 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. Please provide the contact information for the individual at your organization who can provide that information and a representative from the Bellin Health team will follow-up.

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 2017 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) 471-8093.