NEW MEMBER APPLICATIONCity Employees Club

As a Club Member You’ll Enjoy These

VALUABLE BENEFITS:

CITY &DWP Version OUTSIDE

03/2

018

JJLA

: CIT

Y &

DW

P

Join Today!

Join Today!

Up to 60% Off!

DiscountTickets!

DiscountTickets!

CITY & DWPCity Employees Club

New Member Application

Your Club Membership CardYour personalized club membership card will arrive in the mail approximately one week after we receive your membership application.

You’ll want to take it with you everywhere you go — it’s your passport to a world of discounts, benefits, events, connections and fun!

BIG Discounts! & Savings on:• Movie Tickets• Amusement Parks• Attractions• Car Rentals• Hotels• eTickets available

• Omaha Steaks• Hotel Storm• Skechers • Office Depot• Restaurant.com• Avis

• Club VIP Signature Events• Scholarship Program• Free Notary Service

Partner Discounts:

More Benefits:

Up to 60% Off!

Discount Tickets!

Cheap tickets. Insane Service. Affordable Insurance.®

City Employees Club 120 West 2nd Street • Los Angeles, CA 90012(800) 464-0452 • www.cityemployeesclub.com

The City Employees Club is a membership program of LACEA Insurance Services, Inc. (CA DOI Lic. #0B98000). LACEA Insurance Services, Inc. is a licensed insurance agency offering insurance benefits to qualified Club members.

®

NO

PO

STA

GE

NEC

ESSA

RY

IF M

AIL

ED

IN T

HE

UN

ITED

STA

TES

SEA

L W

ITH

TA

PE B

EFO

RE M

AIL

ING

- D

O N

OT

STA

PLE

CIT

Y E

MP

LOY

EE

S C

LUB

OF

LOS

AN

GE

LES

31

1 S

SP

RIN

G S

T S

TE 1

300

LOS

AN

GE

LES

CA

900

13-9

844

NO

PO

STA

GE

NE

CE

SS

AR

YIF

MA

ILE

DIN

TH

EU

NIT

ED

STA

TES

BU

SIN

ES

S R

EP

LY M

AIL

FIR

ST-

CLA

SS

MA

ILLO

S A

NG

ELE

S C

AP

ER

MIT

NO

. 627

22

PO

STA

GE

WIL

L B

E P

AID

BY

AD

DR

ES

SE

E

Artw

ork

for

Env

elop

e, 3

.75

x 8.

5 (3

.75"

x 8

.5")

Layo

ut: s

ampl

e B

RM

Env

with

IMB

.lyt

Oct

ober

3, 2

012

Pro

duce

d by

DA

Zzle

Des

igne

r 200

2, V

ersi

on 9

.0.0

5(c

) 199

3-20

09, E

ndic

ia, w

ww

.End

icia

.com

U.S

. Pos

tal S

ervi

ce, S

eria

l #N

O

IMP

OR

TAN

T: D

O N

OT

EN

LAR

GE

, RE

DU

CE

OR

MO

VE

the

FIM

and

PO

STN

ET

barc

odes

. The

y ar

e on

ly v

alid

as

prin

ted!

Spe

cial

car

e m

ust b

e ta

ken

to e

nsur

e FI

M a

nd P

OS

TNE

T ba

rcod

e ar

e ac

tual

siz

e A

ND

pla

ced

prop

erly

on

the

mai

l pie

ce t

o m

eet b

oth

US

PS

regu

latio

ns a

nd a

utom

atio

n co

mpa

tibili

ty s

tand

ards

.

CIT

Y E

MP

LOY

EE

S C

LUB

OF

LOS

AN

GE

LES

31

1 S

SP

RIN

G S

T S

TE 1

300

LOS

AN

GE

LES

CA

900

13-9

844

NO

PO

STA

GE

NE

CE

SS

AR

YIF

MA

ILE

DIN

TH

EU

NIT

ED

STA

TES

BU

SIN

ES

S R

EP

LY M

AIL

FIR

ST-

CLA

SS

MA

ILLO

S A

NG

ELE

S C

AP

ER

MIT

NO

. 627

22

PO

STA

GE

WIL

L B

E P

AID

BY

AD

DR

ES

SE

E

Artw

ork

for

Env

elop

e, 3

.75

x 8.

5 (3

.75"

x 8

.5")

Layo

ut: s

ampl

e B

RM

Env

with

IMB

.lyt

Oct

ober

3, 2

012

Pro

duce

d by

DA

Zzle

Des

igne

r 200

2, V

ersi

on 9

.0.0

5(c

) 199

3-20

09, E

ndic

ia, w

ww

.End

icia

.com

U.S

. Pos

tal S

ervi

ce, S

eria

l #N

O

IMP

OR

TAN

T: D

O N

OT

EN

LAR

GE

, RE

DU

CE

OR

MO

VE

the

FIM

and

PO

STN

ET

barc

odes

. The

y ar

e on

ly v

alid

as

prin

ted!

Spe

cial

car

e m

ust b

e ta

ken

to e

nsur

e FI

M a

nd P

OS

TNE

T ba

rcod

e ar

e ac

tual

siz

e A

ND

pla

ced

prop

erly

on

the

mai

l pie

ce t

o m

eet b

oth

US

PS

regu

latio

ns a

nd a

utom

atio

n co

mpa

tibili

ty s

tand

ards

.

CIT

Y E

MP

LOY

EE

S C

LUB

OF

LOS

AN

GE

LES

31

1 S

SP

RIN

G S

T S

TE 1

300

LOS

AN

GE

LES

CA

900

13-9

844

NO

PO

STA

GE

NE

CE

SS

AR

YIF

MA

ILE

DIN

TH

EU

NIT

ED

STA

TES

BU

SIN

ES

S R

EP

LY M

AIL

FIR

ST-

CLA

SS

MA

ILLO

S A

NG

ELE

S C

AP

ER

MIT

NO

. 627

22

PO

STA

GE

WIL

L B

E P

AID

BY

AD

DR

ES

SE

E

Artw

ork

for

Env

elop

e, 3

.75

x 8.

5 (3

.75"

x 8

.5")

Layo

ut: s

ampl

e B

RM

Env

with

IMB

.lyt

Oct

ober

3, 2

012

Pro

duce

d by

DA

Zzle

Des

igne

r 200

2, V

ersi

on 9

.0.0

5(c

) 199

3-20

09, E

ndic

ia, w

ww

.End

icia

.com

U.S

. Pos

tal S

ervi

ce, S

eria

l #N

O

IMP

OR

TAN

T: D

O N

OT

EN

LAR

GE

, RE

DU

CE

OR

MO

VE

the

FIM

and

PO

STN

ET

barc

odes

. The

y ar

e on

ly v

alid

as

prin

ted!

Spe

cial

car

e m

ust b

e ta

ken

to e

nsur

e FI

M a

nd P

OS

TNE

T ba

rcod

e ar

e ac

tual

siz

e A

ND

pla

ced

prop

erly

on

the

mai

l pie

ce t

o m

eet b

oth

US

PS

regu

latio

ns a

nd a

utom

atio

n co

mpa

tibili

ty s

tand

ards

.

CIT

Y E

MP

LOY

EE

S C

LUB

311

S S

PR

ING

ST

ST

E 1

300

LOS

AN

GE

LES

CA

900

13-9

844

PO

STA

GE

WIL

L B

E P

AID

BY

AD

DR

ES

SE

E

FIR

ST-

CLA

SS

MA

IL

P

ER

MIT

NO

. 627

22

LO

S A

NG

ELE

S C

AB

US

INE

SS

RE

PLY

MA

IL® ®

To: C

on

tro

ller–

Cit

y o

f L

os

An

gel

es, o

r F

ire

and

Po

lice

Pen

sio

n, o

r C

ity

Em

plo

yees

Ret

irem

ent

Sys

tem

, or

Pay

mas

ter–

Dep

artm

ent

of

Wat

er a

nd

Po

wer

I her

eby

auth

oriz

e th

e de

duct

ion

from

my

sala

ry o

r pe

nsio

n of

am

ount

s su

ffici

ent t

o co

ver

prem

ium

s/m

embe

rshi

p fe

es o

n an

y of

my

grou

p be

nefit

s pr

ovid

ed b

y th

e C

ity E

mpl

oyee

s C

lub.

In th

e ev

ent a

ny

prem

ium

s sh

ould

cha

nge

due

to a

ge, i

ncre

ase

in s

alar

y or

ben

efits

, or

a ge

nera

l rat

e in

crea

se fo

r th

e en

tire

Ass

ocia

tion,

I au

thor

ize

you

to m

ake

such

cha

nge

upon

not

ifica

tion

from

the

City

Em

ploy

ees

Clu

b an

d su

ch

dedu

ctio

n to

rem

ain

in fo

rce

until

can

cele

d by

me

in w

ritin

g.

FO

R O

FF

ICE

US

E O

NL

Y

Cod

e

Ded

uctio

n

City

Em

ploy

ees

Club

311

Sou

th S

prin

g S

treet

, Sui

te 1

300

Lo

s A

ngel

es, C

A 9

0013

1-80

0-46

4-04

52in

fo@

city

empl

oyee

sclu

b.co

m

ww

w.c

ityem

ploy

eesc

lub.

com

Payr

oll D

educ

tion

Auth

oriz

atio

nIn

add

ition

to p

ayro

ll/pe

nsio

n de

duct

ions

for g

roup

ben

efits

, if a

ny, y

ou w

ill re

ceiv

e al

l Clu

b be

nefit

s fo

r a p

ayro

ll/pe

nsio

n de

duct

ion

of o

nly

$6.0

0 pe

r mon

th (a

ctiv

e em

ploy

ees)

or $

4.00

per

mon

th (r

etire

d).

You

auth

orize

thes

e m

onth

ly d

educ

tions

by

sign

ing

the

Payr

oll D

educ

tion

Auth

oriza

tion

form

.

®

Sig

n H

ere

City

/DW

P E

mp

loye

e

Dat

e

X

Ple

ase

sele

ct o

ne:

m C

ity A

ctiv

em

City

Ret

iredm

DW

P Ac

tive

m D

WP

Retir

edmF

ire/P

olic

e Pe

nsio

n (O

ffice

rs O

nly)

Nam

e: _

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

City

Dep

artm

ent #

: __

____

____

____

____

____

____

____

____

____

___

(5 o

r 6

digi

ts)

m C

ity E

mpl

oyee

#: _

____

____

____

____

____

____

__m

DW

P E

mpl

oyee

#: _

____

____

____

____

____

____

__ m

Ret

ired

City

Em

ploy

ee S

SN

#: _

____

____

____

____

____

____

____

____

Mem

bers

hip

is o

pen

to

all

acti

ve a

nd

reti

red

Cit

y of

Los

An

gele

s an

d D

WP

em

ploy

ees.

Soc

ial

Sec

urity

N

umbe

r

03/2018 JJLA: CITY & DWP 03/2018 JJLA: CITY & DWP

Join Today!

Membership Application

Membership in the City Employees Club (The Club) is available to employees of the City of Los

Angeles and the Dept. of Water and Power (DWP).

When you become a member of the Club, you will have exclusive access to amazing membership benefits (like discount tickets and special events). Go to our website,

www.cityemployeesclub.com for all the details.

CALL THE CLUB TOLL FREE:(800) 464-0452

VISIT THE CLUB STORE:120 W. 2nd StreetLos Angeles, CA 90012– FREE validated parking at

Joe’s Parking behind the Club Store. Parking entrance located at 220 S. Spring St., Los Angeles, CA 90012

BUSINESS HOURS:– 8 a.m. to 4:30 p.m., Mon. - Fri.

Harle

m P

l.

W. 2nd St.

3rd St.

Mai

n St

.

Spri

ng S

t.

City Hall

Caltrans/DOT

LAMall

City HallEast

LAPD

Headquarters

1st Street

Temple St.

Los

Ange

les

St.

N

ClubStore

City HallSouth

Ple

ase

sele

ct o

ne:

mC

ity A

ctiv

e

mC

ity R

etir

ed

mD

WP

Act

ive

mD

WP

Retir

ed

mF

ire/

Polic

e Pe

nsio

n (O

ffice

rs O

nly)

Club

Cou

nsel

or

Dat

e /

/

Nam

e of

Ass

ocia

tion

Firs

t N

ame

M

iddl

e In

itial

La

st N

ame

Hom

e A

ddre

ss

City

Sta

te

Zip

Hom

e P

hone

W

ork

Pho

ne

Cel

l Pho

ne

D

ate

of B

irth

(MM

/DD

/YY

YY

)

City

Dep

t. #

C

ity E

mpl

oyee

ID

# (5

or

6 di

gits

)

D

WP

Em

ploy

ee I

D #

m

Mal

e

m F

emal

e

m

Sin

gle

m M

arrie

d

E-m

ail a

ddre

ss*

Ref

erre

d by

M

embe

r N

o.

/

/

(

)

(

)

(

)

Cit

y E

mp

loye

es C

lub

Soc

ial

Sec

urity

N

umbe

r

New

Mem

ber

In

form

atio

n:

City

Em

ploy

ees

Club

120

Wes

t 2nd

Stre

et •

Los

Ang

eles

, CA

9001

2*

The

e-m

ail a

ddre

ss y

ou p

rovi

de w

ill he

lp u

s co

mm

unic

ate

with

you

rega

rdin

g up

date

s an

d be

nefit

s th

at m

ay b

ecom

e av

aila

ble

to y

ou. Y

our e

-mai

l add

ress

will

be

used

sol

ely

by th

e Ci

ty E

mpl

oyee

s Cl

ub a

nd w

ill no

t be

dist

ribut

ed to

oth

ers.

Join the City Employees ClubThe Club is your passport to hundreds of dollars in savings on movie tickets, theme parks, entertainment, and destinations. You’ll automatically receive all Club membership benefits for a payroll deduction of only $6.00 per month.

Find out more about the Club and all its benefits at www.cityemployeesclub.com

Club Members Enjoy:

UP TO 60% OFFDiscount Tickets to movies and attractions like…

• AMC Theaters• Regal/Edwards/UA• Six Flags Magic Mountain• Knott’s Berry Farm• ...and many more.

Club Store 24/7 online access for:• Exciting sporting and special event tickets• Online ordering of discount tickets: no waiting in line!

Other Benefits: • Free Notary Service

(Contact the Club to make an appointment)