Become a Workplace Partner

Required fields are marked with an asterisk (*).

Organization Information

Provide your company or organization name as you would like it to appear on your WPFL certificate and on the membership roster of the Workplace Partnership for Life (e.g., General Motors, United Autoworkers).
The full URL of your organization's website including http(s).

Contact Information

Please do not enter personal information.  Only enter your organization information.
The full name of a person who we can contact with respect to becoming a workplace partner.
Address*