EMPLOYERS ASSOCIATION

Site Map (Table of Contents)

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Company Data

* Organization Name

BWC Policy #

* Street Address

SIC

Mail Address

* # Employees

* City, State, Zip

* County

* Telephone

Fax

* Email Address

* Type of Company

Profit

Non Profit

Gov

Web Site Address

* Principle Business Activity...What does your company produce or sell?

* Are any of your employees represented by a union?

Yes

Unions

Person responsibe for labor relations

Please send a copy of each union contract for our files.

How did you learn about The EA?

Primary reason for joining the EA?

Personnel Information

To whom should we send our:

* Survey Reports

* E-Mail

* Bulletin (Newletter) & Seminar Mailing

* E-Mail

* Additional Training Seminar Information

* E-Mail

You will receive information through E-mail unless you specify a different media. If you do not wish to receive E-mail, please check this box.

Names and titles of officials and staff:

* HR (Primary Contact

* Title

* E-Mail

CEO/President

Title

E-Mail

Safety/Security

Title

E-Mail

Information Services

Title

E-Mail

Training

Title

E-Mail

* Required Information