WCIRB Speaker Request Form

* required field

The WCIRB staff is available to speak to industry groups and associations on a variety of topics. The presentations are designed to help educate industry professionals and stakeholders on California’s workers’ compensation insurance system. If you would like WCIRB to contact you regarding a possible speaking engagement or presentation, please fill out this form. The fields marked with an asterisk (*) are required.

Organization *

Contact First Name *

Contact Last Name *

Telephone *

Email *

Address 1 (Location of Presentation) *

Address 2

City *

State *

Zip Code *

Proposed Presentation Date *

Month

Day

Year

Proposed Start Time (in Pacific Standard Time) *

Hour

Minute

Proposed End Time (in Pacific Standard Time) *

Hour

Minute

Approximate Number of Attendees *

Requested Topic (i.e. Workers' Compensation Overview, Classification, Experience Rating, Inspections, Final Audit, Other) *

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WCIRB Speaker Request Form

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WCIRB Speaker Request Form