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  • Ambassador Engagement Form

    Engagement with the Alliance of Women in Workers’ Compensation Ambassador Program

    Thank you for your interest in becoming a part of the Ambassador Program; there are a few things to be aware of:
    • New chapters will be established and approved by the board
    • Chapters include Ambassadors and committee members
    • Ambassadors and committee members will be approved by the board

    After you have had the opportunity to review our website and understand the mission, if you are interested in engaging with the Alliance’s Ambassador Program, please provide the information requested below and we will schedule time to talk with you.

    With which area of the insurance industry are you engaged:
    AttorneyBrokerCarrierEmployerProviderVendorThird Party AdministratorOther

    Please write a short paragraph on why you want to be involved with the Ambassador Program.

    Thank you for your interest and we look forward to connecting with you!