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 AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific 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. Enter Password Confirm Password Strength indicator To Controller City of Los AngelesI 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) MM slash DD slash YYYY