2019 The Next Step Challenge - Group ID Request
Thank you for your interest in organizing a Live Healthy Iowa (LHI) Challenge within your business, community or organization! Please complete and submit this form at your earliest convenience. Once the form is received, LHI will establish or update your account and send further details via email.
Company/Organization *
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Employee Population *
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Contact Person: *
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Title: *
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Email Address: *
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Phone: *
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Address: *
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City: *
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State: *
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Postal Code: *
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County: *
Payment Method *
*If the company/organization elects to pay for all or a portion of the registration fee, an invoice will be sent to the contact above after registration closes on September 16, 2019.
Required
If you selected 'Company/Organization will pay a portion of the $10 registration fee for each participant with team captains paying the remaining amount at the time of registration', please input the amount to be paid by the company/organization below:
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Statement of Confidentiality: *
By entering my name, I agree to keep participant information confidential and not use privileged information in any way other than the encouragement and promotion of Live Healthy Iowa's The Next Step Challenge.
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