Registration – Workers' Compensation Association

2023 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 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 *

reCAPTCHA

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

Embassy Suites
1040 P St
Lincoln, NE 68508