LAFFA Membership Application – Los Angeles Firefighters Association

Los Angeles City Firefighters Association Membership Form

Name *

First

Middle

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Email *

LAFD Position

Employee ID Number

Date of Birth

Annual $100 Paycheck Deduction

I hereby authorize the deduction from my salary and the payment to LAFFA. Such sum may be properly specified in the By-Laws of the Association.

In lieu of a wet signature, please type your name below:

Date

A Shift

B Shift

C Shift

A Shift

B Shift

C Shift