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Contact Update Form

This form allows you to easily update your training and Employee Protection Line (EPL) contacts with ERMA. This will ensure your contact information is always up-to-date and accurate. If you have any questions or concerns, please email ERMAtraining@sedgwick.com.
1. Please Provide JPA and Agency Info: *This question is required.
2. Agency Address
3. Please choose one of the following: *This question is required.
4. Would this contact like to receive ERMA Training Bulletins? *This question is required.
CURRENT CONTACT INFORMATION:

Please use this section to substitute a training or EPL contact within your organization. You need to provide the details of the existing staff member and the details of the new staff member you wish to add.
Current Contact: *This question is required.
Type of Contact (Select all that apply) *This question is required.
NEW CONTACT INFORMATION:
5. New Contact: *This question is required.
Type of contact (select all that apply) *This question is required.
6. Would you like to add an additional contact? *This question is required.
Additional Contact: *This question is required.
Type of contact (select all that apply) *This question is required.
Would you like to add an additional contact? *This question is required.
Additional Contact: *This question is required.
Type of contact (select all that apply) *This question is required.