Sign up to be an OEBB Wellness Champion

Sign up to be an OEBB Wellness Champion

Are you interested in leading or encouraging wellness efforts in a workplace where OEBB benefits are offered? Complete and submit the form below. No experience required!
As an OEBB Wellness Champion, you'll receive information about OEBB wellness tools, resources, and grant opportunities. We will also invite you to Wellness Champion Network meetings, webinars, live wellness events, and more.

Your participation and feedback will help OEBB provide the resources you need. We appreciate your passion and look forward to helping you succeed!
Full Name*

First NameLast Name
Title
Employer/Entity (organization, building, department where you plan to promote wellness activities) *
Include multiple levels as applicable (example: Eugene SD 4J, North Eugene High School, Transportation Dept.)
Shipping Address (Where UPS can deliver posters/packages. No PO Boxes, please.)*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Phone Number*
10 digits including area code with dashes
What type of phone is the number above?*

Land Line (work)Land Line (personal)Cell phone (work or personal)
Type a question

Type option 1Type option 2Type option 3Type option 4
Does this phone number require an extension? If so, enter it here.*

No extension needed.Other
May we send you text messages with OEBB Wellness Champion information? (standard text message and data rates apply)*

Yes, I agree to receive text messages and phone calls at this number.No, please do not send text messages to this number. Calls only.
E-mail #1 (where you want to receive OEBB Wellness Champion info)*
E-mail #2 (optional - if you have a second address where you also want to receive OEBB Wellness Champion info)
example@example.com
How did you hear about the opportunity to become an OEBB Wellness Champion?*
If "Other", please describe:
Why are you interested in being an OEBB Wellness Champion?
If you could lead your workplace to achieve one Wellness Goal within the next 12 months, what would it be?
What could OEBB do to help you achieve the Wellness Goal you provided above?

Do you know others who might be interested in being an OEBB Wellness Champion? Let us know and we'll send them an invitation.

	Full Name	Email Address	Phone Number	Employer/Entity
1
2

Thank you for helping promote wellness in the workplace!
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