CALIFORNIA WORKERS' COMPENSATION INTERPRETERS ASSOCIATION
CWCIA MEMBERSHIP APPLICATION
Please type your information in the boxes below:

First Name: .Middle Initial: Last Name:
F..... M .....Title:
Membership applicant's classification according to professional and/or business activity (Choose one):
Interpreter, freelance: An independent contractor who personally provides professional services to interpreting businesses, agencies, and institutions.
Interpreter, employee: Employed full time by an institution, business, or agency.
Interpreting business: Operated/owned by an interpreter who personally provides interpreting services to his/her own business accounts and occasionally subcontracts the services of other interpreters.
Agency: Applicant who owns or is employed by an agency, a business that provides interpreting services mostly by sub-contracting freelance interpreters.
Other: Please describe
Associate Member: One who is part of an interpreting business or agency with at least one CWCIA member in good standing.
Name of Business/Organization/Employer:
Business Address: (Street)
City: State: Zip Code:
Bus. Tel: Bus. Fax: Bus. E-mail:  
Home Address:
City: State: Zip Code:
Hm. Tel: Hm. Fax: Hm. E-mail:
Select ONE Region: Bay Cities | Central CA | Central Coast.| Inland Empire | Los Angeles
Orange County | Northern CA | San Diego | Ventura
Preferred mailing address: Business..... Home ......Preferred notification: E-mail ..... Bus. Tel.
FOR PROFESSIONAL INTERPRETERS:
Languages: 1 2 3
Currently active interpreting certification Issued by the State of California:
Language: Court..... Administrative..... Medical
Please select a committee you may be interested in participating: Communication Committee
Issues, Plans, & Objectives | Membership Committee | Special Action Committee
MEMBERSHIP FEES:
The annual membership fee of $75.00 covers one (1) full year from the date membership is approved. Membership fees will become due every twelve months thereafter.
Check enclosed for $75.00
Check #: Date: CK Amt: Issued By:
Membership dues are deductible as a charitable contribution for Federal Tax purposes
Membership once approved, is not refundable nor transferable.
Each member is entitled to one vote, his/her own.
CWCIA members must abide by the by-laws, applicable rules and ethics code of this Association.
Please sign this CWCIA Membership application form and send it in with your check to:
CWCIA, 23441 Golden Springs Road, #109, Diamond Bar, CA 91765
 
Applicant's Signature ________________________________________ Application Date _________________
For a referral to get additional information on this application or CWCIA,
please email us or call Lupe Manriquez at 909/860-1636.
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