Healthiest Manitowoc County

Healthiest Manitowoc County is a community coalition providing collaborative leadership to improve the health of Manitowoc County and envisions a community where everyone is living longer, better. We are a neutral party and cannot partner or sponsor anything in conflict of interest to our organization or that does not align with our mission and vision. Please complete the entire form below to be reviewed by the appropriate party. All requests will be approved or denied within 3-5 business days after submission. If you do not hear a response, have questions, or want to retract your request, please contact lexiotis@co.manitowoc.wi.us

Name *

Company or Organization Name (if not applicable, please enter N/A) *

Company or Organization Address (if applicable)

City

State/Province

Zip/Postal

Country

Phone *

Email *

Are you a member of Healthiest Manitowoc County? *

Yes

No

Please provide a brief description below of all materials the logo will appear on and how it supports the mission and vision of HMC. Note that approval is only for materials described in this form. *

Would you like to give permission to Healthiest Manitowoc County to use your company's logo on their website and in promotions for your company's buisness? *

Yes

Not at this time

If you would like to give permission to Healthiest Manitowoc County to use your company's logo, please upload the logo here

Maximum upload size: 104.86MB

Logo Request