WSDA Retro Application

Complete the following application to enroll in the free, members-only WSDA Retro program. Please do not close this window mid-application. If you close the window, your progress will be lost.

Participant Information

Practice Information

UBI and L&I Numbers


The application requires your UBI and L&I account number. You can search for both using this tool from L&I.

Search UBI and L&I Numbers

Claims Contact Information

If claims contact is same as primary owner, check here and skip.

Acknowledgment of Participation Agreement

As an applicant to participate in WSDA Retro, I hereby acknowledge and agree to the terms and conditions as set forth in the Group Retrospective Rating Program Participation Agreement. Click here to read the agreement.
Check this box to agree to the participation agreement.

How to Complete Your Application

Applicants must e-sign a required Department of Labor & Industries (L&I) form to finalize their WSDA Retro application. Please review the following steps before pressing submit.

  1. Within 1-2 business days of submitting this form, you will receive an email from Adobe Acrobat Sign on behalf of Natalia Hilal (adobesign@adobesign.com).
  2. Click "Review and Sign" to e-sign this required L&I form.
  3. Once you have e-signed the form, your application will be complete.



WSDA Retro Powered by ERNwest
Questions? Please contact Natalia Hilal at NataliaH@wsda.org.
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