Registration – Workers' Compensation Association

Please use the form below to sign-up and pay for registration.

Embassy Suites
1040 P St
Lincoln, NE 68508

Wednesday October 10^th, 2022 will be the last day to cancel your registration for a full refund. Cancellation requests after this date are subject to review by the Nebraska Symposium committee. If you need to cancel your registration, please click here and provide your information with written notice of cancellation.

2022 Nebraska Symposium Registration

First Name *

Last Name *

Company *

Job Title *

Nursing License Number *

PT/PTA License Number *

AT/BOC License Number *

Attorney License Number *

CCM Number *

Address *

Address

City

State/Province

Zip/Postal

Email Address *

Select Early Registration *

Select Regular Registration *

Payment Method *

Please mail checks to:

PO Box 24054
Omaha, NE 68124

Make checks payable to “Workers' Compensation Association of Nebraska”

Credit Card Holder First Name *

Credit Card Holder Last Name *

Cardholder Address *

Cardholder Address

City

State/Province

Zip/Postal

Credit Card *

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