Education Services Order Form
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Education Services Order Form. This is a Connecticut form and can be use in Workers Compensation.
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State of Connecticut Workers' Compensation Commission Education Services Order Form Name _____________________________________________ Telephone: ________________________ Position ___________________________________________ Email: ____________________________ Organization __________________________________________________________________________ Address ______________________________________________________________________________ City ____________________________ State ____________________________ Zip________________ Please mark the item(s) below that you would like to receive FREE of charge: _______ Information Packet--overview of workers' compensation, includes a 30C claim form English Spanish _______ Pocket Guide to Workers' Compensation English Polish Portuguese Spanish _______ Bulletin--Workers' Compensation Act, related statutes, regulations and more _______ A Guide to 1996 Workers' Compensation Reform Legislation _______ A Guide to 1995 Workers' Compensation Reform Legislation _______ Summary of 1993 Workers' Compensation Law Changes _______ Subscriptions--Please add me to the following Chairman's Mailing List: Attorney Insurance Medical Practitioner Union Mail this Order Form to: Workers' Compensation Commission Education Services Capitol Place - 4th Floor 21 Oak Street Hartford, CT 06106-8011 American LegalNet, Inc. www.FormsWorkFlow.com
