DATA CALL ENROLLMENT REQUEST

After completing the Data Call Enrollment Form below, you will be added to the Workers' Comp Research & Analysis Unit data call list and receive email data call notifications.

Also use this form to update your contact information or to be removed from the data call list.

 
           
First Name  
Last Name  
Business Name  
Email Address  
Telephone  

Check the ONE Category that best describes your Affiliation
  If Other Please explain