Payroll Deduction Form - Los Angeles City Attorneys Association

Authorization for Payroll Deduction for Association Dues

Los Angeles City Attorneys Association

Information is collected for internal use only. LACAA will never share your personal information without your prior consent.

Name(Required)

First Last

Employee ID Number(Required)

Department(Required)

Home Address(Required)

Street Address Address Line 2 City State ZIP Code

Email(Required)

Used for receiving emails from LACAA and as your login ID. LACAA recommends using a personal email address.

Cell Phone(Required)

Password(Required)

You will need a password in order to access the website, once your membership is approved. Please enter your desired password in the fields below.

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To Controller City of Los Angeles

I hereby authorize the City to deduct membership dues and transmit them to the ASSOCIATION OF LOS ANGELES CITY ATTORNEYS (LACAA). These deductions are to be based on schedules which LACAA files from time-to-time with the City and are to be deducted each pay period specified by the City for such deductions. The Dues payments to LACAA are set forth in Article 8 of the Bylaws of the Los Angeles City Attorneys' Association. This authorization will remain in effect until cancelled by me in writing.

Dues payments to LACAA are not deductible as charitable contributions for Federal tax purposes. Dues payments may be deductible as a miscellaneous itemized deduction.

Electronic Signature Acknowlegement(Required)

By checking "I agree" you agree and acknowledge your electronic signature is valid and binding in the same force and effect as a handwritten signature, that all the information contained in this application are true, correct and complete to the best of your knowledge, information and belief.

I agree

Electronic Signature of Employee(Required)

Date(Required)