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* 1. What is your first and last name? (*First and last name are required in order to earn points)

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* 2. What is your employee ID? (*If you are a spouse/LDA, please enter the employee ID number you participate under)

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* 3. I am a:

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* 4. I am a colleague/spouse/LDA of:

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* 5. Current LiveWELL Level?

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* 6. What is your favorite LiveWELL challenge category so far? (select one)

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* 7. Tell us what you have liked most about HSHS LiveWELL and/or share your success story.

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* 8. HSHS will highlight colleague stories each month on the HSHS Benefit website (Share Your Story examples) and/or in other publications. Are you interested in sharing your story publicly?

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* 9. What type of LiveWELL challenges would you like to see in the future?

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