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Workers Compensation Insurance Premium Indication Request 3658FOR MEMBERS OF THE CALIFORNIA OPTOMETRY ASSOCIATION For more information complete the form below and fax to Mercer at: 2133465946, or

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What is for members of form?

For members of form is a document that collects information about the individuals who are part of a specific group or organization.

Who is required to file for members of form?

The individuals who are responsible for managing the group or organization are required to file for members of form.

How to fill out for members of form?

To fill out for members of form, individuals need to provide information about each member, such as their name, contact information, and role within the organization.

What is the purpose of for members of form?

The purpose of for members of form is to maintain a record of all the members within a group or organization for reference and communication purposes.

What information must be reported on for members of form?

The information that must be reported on for members of form includes the full name, address, phone number, email address, and position/title of each member.

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