State of Connecticut Workers' Compensation Commission

Education Services Order Form
Name _____________________________________________ Telephone No. _____________________ Position ______________________________________________________________________________ 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 No. 47--Workers' Compensation Act, related statutes, regulations and more _______ Bulletin No. 47 Supplement--annotations to Compensation Review Board opinions _______ 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