ONLINE Membership Application Form for 5 or More at 20% Discount

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.

IMPORTANT: For multiple registrations, AFTER CHECKOUT, you will be re-directed back to this page where YOU MUST fill in and submit the contact information form below for each applicant. You will not need to make any further purchase selection.

 
   
ONLINE REGISTRATION:    
Members ($60 Each):
Select Number of Memberships
 
 

MEMBER CONTACT INFORMATION

Submit Information Below ONLY AFTER you have checked out.

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 Fee for 5 or more - $60.00
(Limited to Workers' Compensation Adjudicators & Administrative Officials)
 

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.