Mar 31, 2015 - Submit this form to the mailing address, email or fax number listed below. Email:
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