Let us know which activities you implemented for the Well Wisconsin Champion Contest by completing this submission form. Put a check by the activities you completed between January 1 and May 31 and we'll tally up your points. Complete five activities from the list below to earn 50 points and submit by May 31.

Round 1: January 1 through May 31
Round 2: June 1 through October 31

Stay tuned for more details on the second round of the contest! Contact us at wellwi-employersupport@webmd.net with any questions.

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* 1. First Name:

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* 2. Last Name:

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* 3. Employer:

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* 4. Email Address:

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* 5. Select the activities below that you completed for round 1 (Jan 1- May 31) submission:

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* 6. If you completed the Champion's Choice activity, tell us about what you did.

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