Stairs for Wellness Challenge 2014 Registration

Please complete the below form to register for Wellness Options at Work's Stairs for Wellness Challenge.

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* 1. Please enter the following information:

Last name:

First name:

email:

Inter-D Mail code (If no mail code, please provide work address):

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* 2. Please select the organization you work for:

UWHC

UWMF

SMPH

Friend/Family member of a UW Health employee

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* 3. Do you need a Brochure/log form sent to you?

Yes

No

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* 4. Please select your t-shirt size:

Small

Medium

Large

X-Large

2XL

3XL

Repeating the challenge, would like a different prize.