We are excited to have a family member join you for the 2019 Wellness Program!

Complete all of the information below to register your family member (spouse or adult dependent). Only 1 eligible spouse or adult dependent (between the ages of 18-26) is able to participate in the 2019 Annual Wellness Program.
 
Prizes
  • Annual Wellness Program - Wellness All Star shirt (must complete annual program requirements and 2 out of the 3 Sibley Challenges)
  • Sibley Sponsored Challenges = 50 points each 

*Read specific challenge guidelines for more details regarding eligibility and prizes. 
 

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* 1. Employee Name (First and Last)

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* 2. Who are you registering?

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* 3. First Name (Spouse or Adult Dependent)

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* 4. Last Name (Spouse or Adult Dependent)

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* 5. Email Address (Spouse or Adult Dependent)- challenge emails and program information will be sent to email address given

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* 6. T-Shirt Size (Spouse or Adult Dependent)

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* 7. I understand that I can register only one spouse or adult dependent to participate in the 2019 Annual Wellness Program along with me. The family member must complete the annual requirements (earn 300 wellness points, physical exam form, online health risk assessment) and participate in Sibley challenges in order to receive any eligible prizes. The spouse or adult dependent is not eligible for the monetary wellness reward or other cash prizes (including gift cards).

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