PCRB Membership Form

 

Online Submission This version of the form can be completed online and e-mailed to the Bureau.

You must have an installed copy of the Adobe Acrobat Reader version 9.0 or higher on your computer. Download the Free Acrobat Reader.

In order to e-mail the form to the Bureau you must have a configured E-mail Client (such as Microsoft Outlook, Outlook Express, Lotus Notes, etc) installed on your computer.

 
 
Manual Submission This version of the form can be completed online, printed and mailed or faxed to the Bureau

You must have an installed copy of the Adobe Acrobat Reader version 6.0 or higher on your computer. Download the Free Acrobat Reader.

The form must be mailed to:

Attention: Bruce Decker – Senior Vice President
PCRB Membership Application Form
Pennsylvania Compensation Rating Bureau
United Plaza Building, Suite1500
30 South 17th Street
Philadelphia, PA 19103

Or faxed to: (215) 320-4580,
Attention: Bruce Decker – Senior Vice President
PCRB Membership Application Form