wellness award order form - Tacoma Wellness - City of Tacoma

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Mar 31, 2015 - Submit this form to the mailing address, email or fax number listed below. Email: [email protected]
WELLNESS AWARD ORDER FORM This form is due by March 31, 2015. No Exceptions.

EMPLOYEE INFORMATION (Please Type or Legibly Print) Name: __________________________________________________ Employee ID #: ____________________________

Date: _________________________

Work Location: _______________________________

Email: ____________________________________________

Phone #: ____________________________

Catalog Item Description and # ______________________________________________________________ Preferred Mailing Address for Award (cannot be a PO Box):

Submit this form to the mailing address, email or fax number listed below. Email: [email protected]

Fax: 253.591.5873

OR Mail to: Wellness Coordinator City of Tacoma, Human Resources Department 747 Market Street, Room 1448 Tacoma, WA 98402