CALIFORNIA WORKERS’ COMPENSATION
                                            DEFENSE ATTORNEYS’ ASSOCIATION, INC
                           Northern California Workers’ Compensation Defense Attorneys’ Association (NCWCDAA)

                                        New /Renewal Membership For _________ (Year)

                         Managing Attorney                    Partner/Shareholder             Associate Attorney               Staff Council

Name:                                                                                                            State Bar#:

Firm Name:
City:                                                                                      , CA Zip Code:
Office:                                                                          Direct:
Cell:                                                                            Fax:
     Contact me for more information

The California Workers’ Compensation Defense Attorneys’ Association, Inc. (CWCDAA) is a federation of California attorneys and
their professional associations engaged in the private practice of workers' compensation law on behalf ofemployers and their
insurance companies. Member Associations include the Northern California Workers’ Compensation Defense Attorneys’ Association
(NCWCDAA) and the Southern California Workers’ Compensation Defense Attorneys’ Association (SCWCDAA). The highest
quality of continuing legal education is offered in specialized area of law as well as an opportunity for our members to come
together to address the critical issues within our profession. Founded in 1979, our mission is to provide California employers and their
insurance companies with the highest quality of specialized legal representation before the California Workers' Compensation
Appeals Board.
Association by-laws permit membership to individual attorneys, duly licensed and actively engaged in the private practice of law
in the State of California, who devote a substantial part of their practice to representation of employers and insurance carriers in
workers’ compensation litigation in California. The NCWCDAA is members residing in Inyo, Kern, or San Luis Obispo counties
and Northward. Non-voting associate memberships are available to those staff attorneys employed in-house by public agencies,
employers or insurance carriers.
All members receive reduced price registration fees for Association conferences, meeting and seminars. Annual Individual
Membership dues for calendar year are $249.00. Annual Individual Membership dues of $224.00 are available for those Firms with
15 or more attorneys who join all Firm members. New Member dues are $199.00 for first year.
                   If you would prefer payment by credit card, please fill out the information below.

Credit Card:        VISA         MASTERCARD                                                          Total Submitted: $

Card #:                                                                                                          Exp Date:
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Up to $99 of your membership dues may be used as a contribution to the CWCDAA PAC. This is a non tax-deductible contribution. If you do not wish to make such a
contribution, please check this box

Makes checks payable to “NCWCDAA”

Mail Registration forms to:          StageOne Events                 Tel: (925) 240-9160
                                     c/o NCWCDAA                     Fax: (925) 240-1996
                                     PO Box 1238
                                     Brentwood, CA 94513
Revision 9/25/09                                                                                   Date Received:

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