The 2014 Florida Bar Workers Compensation Page 2
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2The Florida Bar annual Workers’ CompensaTion Forum
April 10th — 11th, 2014
*REMINDER to ADJUSTERS! To maintain the “CWCL” designation, adjusters
must attend the Forum at least once every 3 years. If you secured your designation
in 2008 & 2011 and haven’t attended since, you must attend the 2014 Forum to
keep the designation.
This is the perfect program for supervisors, case managers, risk and insurance
professionals, and vocational experts who wish to increase their depth of
knowledge and understanding of Florida’s workers’ compensation litigation
environment.
*Note: This is a 2-day event. For initial CWCL certification, attendance is required
at all sessions of Track 1. Failure to attend all sessions, or leaving for any reason,
will forfeit one’s eligibility for the Board Certified W/C Litigation Adjuster “CWCL”
designation and CE credit. Those who have achieved their “CWCL” designation are
free to experience any part of the Forum; however, you must attend both days of
the conference to maintain your designation.
Adjuster/Claim Supervisor/ RN Case Manager/Other Registration Form
Register me for the “2014 Florida Bar Workers’ Compensation Forum” (April 10-11, 2014)
MAIL: Send to The WCCP Association at PO Box 128, Dade City, FL 33526, or for Overnight Mail to 31251 Reed Road, Dade City,
FL 33523, with a check in the appropriate amount payable to The WCCP Association, or credit card information filled in below. Please
call (800) 642-7774 for additional assistance.
Please Register (Name) __________________________________________________ License #’s ______________________________________
Company/Firm Name ______________________________________________________ Daytime Phone __________________________________
Address ________________________________________________________________ Email Address: __________________________________
REGISTRATION FEE (CHECK ONE):
WCCP Member - Adjusters, Claim Supervisors, RN Case Managers $169.00 ____
WCCP Member - Vocational Experts and Disability Professionals $249.00 _____
Non-WCCP Members - Adjusters, Claim Supervisors, RN Case Managers, Vocational Experts or Disability Professionals, Other: $325.00 ____
(**Memberships must be current**)
On-Site Registrations: Add $40.00.
*IMPORTANT: For Board Certified (CWC) Professionals Only! _____ Initial CWCL Designation
(First-time attendee)
(Please check one…)
_____ Maintaining CWCL Designation
METHOD OF PAYMENT (CHECK ONE): _____ Check enclosed made payable to The WCCP Association
_____ Credit Card (Master Card, Visa, AmEx, Discover. Please Fax to 866-616-1220)
Name on Card __________________________________________________________________________________
Credit Card Number _________________________________________________ Exp Date: ________________ *Security Code _______________
Billing Address (where you receive your billing statements) ________________________________________________________________________
Street or P.O. Box
City
State
Zip
Signature: __________________________________________________ *Email Address: ______________________________________________
(**Note: For credit card charges, an email address is mandatory. You will receive an email receipt immediately upon processing**)
_____ Please check here if you have a disability that may require special attention or services. To ensure availability of appropriate accommodations, attach a general
description of your needs. We will contact you for further coordination.
REFUND POLICY: All refunds will incur a $30.00 processing fee. Deadline for refund requests is March 14, 2014. Absolutely no refunds will be given after this date, as we
must give guarantees to the hotel. Registration fees are non-transferable, unless transferred to a colleague registering at the same price. A $30.00 fee will be incurred for
checks returned as non-payable due to non-sufficient funds.
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