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PWC Firm Membership, 2024-2025
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Type of Membership
*
Choose
Firm Membership 1 of 3
Adding Firm Member 2 of 3
Adding Firm Member 3 of 3
Please make this a Flex Firm Membership
More information on Flex can be found by
clicking here
.
Yes, please make this a Flex Firm Membership
Member First Name
*
Your answer
Member Last Name
*
Your answer
Member Credentials
(e.g., CDMS, RN, MD, PhD, etc., or NONE)
*
Your answer
Company/Firm Name
(For members 2 & 3, you may answer "Same")
*
Your answer
Profession / Job Title
*
Your answer
Service Category
*
Choose
Claims Administration
Employer / Retro Representative
IME Services
Interpreters
Legal Representatives
Medical Case Management
Specialty Consultants
Treatment Providers
Vocational Services
Member email
*
Your answer
Company Website
Your answer
Member's Primary Contact Phone
Use (###) ###-#### format
*
Your answer
Member's Phone Ext
Your answer
Fax Number
Use (###) ###-#### format
Your answer
Mailing Address, Street
(if same as previous Firm Member, skip and go to Zip Code)
Your answer
Mailing Address, City
Your answer
Mailing Address, State
WA
Other:
Mailing Address, Zip
*
Your answer
Additional Member Information (interests, specialties, etc.)
Your answer
Volunteer Interest:
Want to serve on the Board? Want to help with programs? With communications? With the website? Let us know!
Your answer
Email of person completing form:
(If completing for Firm Members 2 and 3, you may answer "Same"
*
Your answer
Security quiz: What is 9 minus 4?
*
Your answer
Submit membership registration
Membership registration is not complete until payment is received.
To submit payment, after completing this form please click on the "Payments" link at the bottom of this page, or at the top of our homepage.
Questions?
Email us at Contact@PWC.org, or call us at (206) 249-7922.
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