Become a Club Ambassador! Complete this form.

SPACER

PERSONAL INFORMATION

First Name Middle Initial Last Name

Home Address City State ZIP / Postal Code

Home Phone

Mobile Phone

Personal Email Address

* The e-mail address you provide will help us communicate with you regarding updates and benefits that may become available to you. Your e-mail address will be used solely by the Employees Club of California and will not be distributed to others.

Birth Date

Gender

Male
Female

Marital Status

Married
Single

What t-shirt size do you wear?

Club Ambassadors will receive a free t-shirt.

REFERRED BY

If you were referred to this program by another member, please provide their Name and Member ID number.

SPACER

WORK INFORMATION

Which government entity do you work for?

City of Los Angeles
County of Los Angeles
LAUSD
State of California
Los Angeles DWP

Department you work for:

Job Title:

Date of Hire (MM/ DD/ YYYY)

Work Phone

Work Email Address

* The e-mail address you provide will help us communicate with you regarding updates and benefits that may become available to you. Your e-mail address will be used solely by the Employees Club of California and will not be distributed to others.

TERMS AND CONDITIONS

The Club Ambassador Circle is a voluntary Club Representative program of the Employees Club of California exclusively for qualified members of the Employees Club of California. Club members do not have to pay extra dues or fees to be part of the Club Ambassador Circle, but must adhere to, and maintain, the eligibility requirements set forth in this program. There are no monetary compensation as an Ambassador for the Club, however, exclusive Club Ambassador benefits will be provided. If a member cancels his or her Club membership, their associated Club Ambassador status will automatically end. The Club reserves the right to eliminate the Club Ambassador program and revoke a member’s Club Ambassador status at anytime without notice. Club Ambassadors will work with the Club by providing Department feedback to help expand the Club’s Membership and benefits that will enhance the work and lives of government employees.

AGREEMENT

By submitting this application, I confirm that the above information is correct, that I am a member of the Employees Club of California in good standing, that I acknowledge my duties as an Ambassador of the Club, and that I agree to all the terms indicated in the above Terms and Conditions section of this application.

Type your first and last name here to accept the Agreement.

FINAL STEP: Click SUBMIT to send your Club Ambassador application to the Club.

Make sure you have completed all relevant fields.

Comments

This field is for validation purposes and should be left unchanged.

For more information and details:

CLUB Ambassador Application

SPACER

PERSONAL INFORMATION

REFERRED BY

SPACER

WORK INFORMATION

TERMS AND CONDITIONS

AGREEMENT

FINAL STEP: Click SUBMIT to send your Club Ambassador application to the Club.

Make sure you have completed all relevant fields.

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