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Springo BINGO!
This is the sign-up form for the ILEE Wellness 2019 Spring challenge. If you would like to participate, please fill out the form below. Be sure to select your t-shirt size!
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* Indicates required question
First & Last Name
*
Your answer
Email Address
*
Your answer
Which facility do you currently work at?
*
Choose
Avita Senior Living at Rolling Hills
Axiom Healthcare Services
Derby Assisted Living
Derby Health & Rehab
Family Health & Rehab
Flatirons Health & Rehab
Nottingham Health & Rehab
Reeds Cove Health & Rehab
St. Anthony's Senior Care Hospital - Olathe
St. Anthony's Senior Care Hospital - Wichita
What is your shirt size? (All sizes are unisex)
*
XS
S
M
L
XL
XXL
XXXL
Would you like to receive text messages from your Wellness Champion regarding the challenge, such as reminders?
*
Yes
No
If yes, who is your mobile carrier?
Verizon
AT&T
Sprint
T-Mobile
Cricket
Other:
Clear selection
If yes, what is your cell phone number? (with area code)
Your answer
Submit
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