ONLINE Membership Application Form

NATIONAL ASSOCIATION OF WORKERS’ COMPENSATION JUDICIARY

To register online, please select from choices below.
If you prefer to pay by check, click here for the mail-in form.
Register 5 or More and Receive a 20% Discount: click here.

Full Name:
Governmental Agency or Court:
Title:
Business Mailing Address:
City:
State:
Zip:
Telephone Number:
Fax Number:
Email Address:
Judiciary Number:
CLE Number:
State/Jurisdiction/Association:
 
Referred by:    
NAWCJ Member
NAWCJ Associate Member
Other     
   
 
What position do you hold?    
Judiciary     
Attorney
Other     
     
 
Membership Registration Fees  
Member $75
(Limited to Workers' Compensation Adjudicators & Administrative Officials)
Associate Member $250 (Attorney, etc.)
 

METHOD OF PAYMENT

BY CLICKING SUBMIT, you will be directed to our secure online PayPal payment page.

For more information, contact the National Association of Workers'
Compensation Judiciary at (850) 425.8156 or 425.8155. 

Contributions, gifts, or dues to the National Association of Workers' Compensation Judiciary are not deductible as charitable contributions for federal income tax purposes.