Indiana Worker's Comp Institute Board Member Application

Membership on the Indiana worker’s Compensation Institute (IWCI) Board is regulated by the organization's bylaws (available on the IWCI website). While the bylaws limit the number of members of the Board, the Board has the right to further limit that number in order to maintain an effective working body. Your application to the Board will be carefully reviewed in connection with the need for additional members, the skills you will provide, and the constituency that you represent.

    Board Member Application
*Chapter:
*Name:
*Company:
*Email:
Address:
 
City:
State:  Zip:
Phone:

Describe your professional experience and involvement with the Indiana worker’s compensation system:


Describe your interest in service as an IWCI Board Member; including interest in any particular Institute activity:


Describe any previous or current service to the IWCI including length of membership, if applicable, and event speaker, volunteer or sponsor:

 (Audio)

*Enter the above letters: