The National Registry of Workers' Compensation Specialists

Membership Application

The National Registry of Workers' Compensation Specialists™
140 North 3942 East, Rigby, ID 83442

Phone 1-208-360-1972
Fax 1-877-764-3294
E-Mail: contact@nrwcs.com

Membership Application for NRWCS

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First Name:

Last Name:

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Check Here for Insurance CE credit (See website to determine which states currently offer credit.)

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Please Read the Following Statement carefully before signing/submitting:

I hereby submit this application to The National Registry of Workers’ Compensation Specialists and declare that all information to the best of my knowledge is accurate and complete. If approved, I shall abide by the rules, regulations and Code of Ethics of NRWCS. I also agree to complete a minimum of 15 hours of continuing education every three (3) years and supply proof of credits earned to NRWCS during the required reporting period. I also understand that my name, company, business telephone number and /email address will be shown on the Internet unless specifically requested.

Check Here- To request that your name and information be withheld from the NRWCS website and we will remove your name from the internet.

Payment Information

Check Payment. I will send a check via mail for tuition fees of $425.00.

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