Membership Application

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
C/O: Erin Frahler
Empire Pacific Risk Management
5300 SW Meadows Rd.
Lake Oswego, OR 97035
(503) 968-6300

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).