Retired Associate Membership Application

Step 1 of 5

IMPORTANT: This application is for NEW RAM members ONLY.

Member Information

Name(Required)

First Last

Agency/Association(Required)

(No abbreviations please)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Email(Required)

Cell Phone(Required)

Date of Birth(Required)

Retirement Date(Required)

Were you a sworn peace officer or non-sworn personnel?(Required)

Sworn Peace Officer under PC 830 Non-Sworn

Non-Sworn

Do you have an existing PORAC member number?(Required)

Yes

Unsure

Member Number(Required)

Identification Card(Required)

If you do not have a PORAC member number, you MUST submit a copy of your retired identification card (front & back). Please upload below, fax to (916) 999-8890, email ramsam@porac.org or mail a copy to PORAC RAM, 2940 Advantage Way, Sacramento, CA 95834.

NOTE: Your RAM application CANNOT be processed until we have received a copy of your retirement ID.

Accepted file types: jpg, jpeg, gif, pdf, tif, png, Max. file size: 3 MB.

Employees Club of California

Please complete the following Payroll Deduction Authorization Form and return it to the Employees Club of California. Your payroll deduction will become effective as soon as the City Controller processes your request. Please note it can take up to two pay periods for the City Controller’s office to process your deduction. The Club will do everything possible to ensure your payroll deduction gets processed sooner.

Member Information

Name(Required)

First Middle Last

Address

Street Address Address Line 2 City State ZIP Code

Email*(Required)

Cell Phone(Required)

The email address you provide will help the Club communicate with you regarding important updates and benefits that may become available to you. Your email address is used solely by the Employees Club of California and will not be distributed to others.

Deduction Status Update

Please select the reason for your change/update to your deduction.(Required)

I’ve changed departments within the City

I’ve retired/ or will be retiring

I am a Surviving Spouse

Other

Date of Birth(Required)

Retirement Date(Required)

City Department Number(Required)

City Employee Number(Required)

Payroll/Pension Deduction Authorization

I hereby authorize the deduction from my salary or pension of amounts sufficient to cover premiums/membership fees on any of my group benefits provided by the Employees Club of California. In the event any premiums should change due to age, increase in salary or benefits, or a general rate increase for the entire Association, I authorize you to make such change upon notification from the Employees Club of California and such deduction to remain in force until canceled by me in writing.

Member's Signature(Required)

Signature Date(Required)

Member Information

Membership Type and Renewal Information

Signature

Refund Policy

Employees Club of California

Member Information

Deduction Status Update

Payroll/Pension Deduction Authorization

Payment