Attendee Information (*)

First Name + pronouns if desired *

Last Name *

Primary Job Role: * Executive Human Resources Other (Please list) Public Health Student Worksite Wellness

Worksite *

Industry: * Education Financial Government Health Care Manufacturing Non-profit Other (Please list) Professional Public Service

# of Full-Time Employees *

State: * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

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Zip: *

Email: *

The Health & Wellness Coalition is celebrating 20 years of Working Well Conferences. How many years has your organization been focusing on wellness? (ideas include: education, programs, environmental changes, policies) Beginning: 1-2 years Bold: 3-5 years Beyond: 6+ years

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