Group Size Verification Form * Required Information Enter your information below Group Number* Group Name* Total number of full and part-time employees at all company locations* First Name* Last Name* Email Address* By entering my name below, I certify that to the best of my knowledge and belief, the information on this form is true and accurate. Signature * First Name* Last Name* Confirm Signature * First Name* Last Name* Check the box to confirm the answers you provided are accurate.* Submit See our privacy statement for more information about our policies. Thank you! Thank you for your submission.