COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT Division of Workers' Compensation 633 17th St., Suite 400 Denver, CO 80202-3626 ENTRY OF APPEARANCE Claimant Employer Insurer Workers' Compensation Number Date of Injury Claimant Social Security Number Youareherebynotifiedthattheundersignedattorneyisenteringhis/herappearanceintheabove-captioned matter.Iamrepresentingthefollowing client. (1) (2) (4) (5) Claimant Carrier Employer Other (Name of party) (Name of party) (Name of party) (Name of party) (3) Dependent Attorney (print name) AttorneyRegistrationNumber Address City Phone AttorneySignature WC6Rev08/17/15 American LegalNet, Inc. www.FormsWorkFlow.com OfficeCode State ZipCode