Membership Application | Worker's Compensation Claim Association

Use the form below to submit your application either by mail or electronically.When you hit continue you will be taken to a confirmation page. You can print the confirmation page and mail it to the address below or just click submit to email the registration.

WCCA
PO Box 1830
Lake Oswego, OR 97035

WCCA Tax ID 47-3268248

Dues Schedule	Company / Individual Membership
Membership Dues	$50 / $25

To determine your tier: count your Oregon workers’ comp technicians and supporting staff (managers, examiners, assistants, etc), those who manage or process claims, or are otherwise involved with claims management or workers’ compensation (case manager, risk manager, loss control, nurse case manager, vocational rehabilitation, etc).

Membership Form For *

Membership Year

Membership Dues

Payment OptionsCheck will be mailed within 5 daysCheck will be brought to the event

First Name *

Last Name

Company Name

Email Address *

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Phone Number

Fax Number

Business Type *

If Other Please Describe

If others in your company would like to be added to the mailing list, click here.