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Our organization would like
to become a member of the Workers Compensation Research Institute.
We have read the material describing WCRI, including the Bylaws, and
agree to the terms of membership.
application form may be completed in two ways.
Please complete all fields on the application
form, including the Primary Contact on the Member Distribution list,
before submitting the application.
The 2013 employer assessment formula is:
The employer assessment formula recognizes
three groups according to the general level of hazard in the
Group A: Principal business in
construction, most manufacturing, mining, agriculture
Group B: Principal business in light
manufacturing, transportation and public utilities, certain
Group C: Principal business in
retail, wholesale trade, financial services and most other services
All groups are subject to a $20,000
maximum assessment and a $6,300 minimum assessment.
In order that we may disseminate
information about the Institute and our research to the
appropriate people within your organization, please designate
those who should receive our communications.
The Primary Contact is the
person who represents your organization in all matters requiring
votes. The Alternate
is the designee to act in the absence of the Primary Contact. All individuals
listed receive WCRI FLASHREPORTS
and other electronic communications keeping those on
your list informed in advance of the latest WCRI research.
check to see that all information is correct and then click
Submit Application. We will invoice you for the assessment fee.
If paying by check,
please print this form and mail with the payment to the address below.
955 Massachusetts Avenue
Cambridge, MA 02139
information, please contact WCRI at 617-661-9274 or email us at
Massachusetts Avenue Cambridge, Massachusetts
02139 617-661-WCRI (9274)
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