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Website administered by:
YorkWare Graphic Design
© 2006 All Rights Reserved
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Membership & Benefits Forms
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The
membership form is to be used by new members to
submit their initial information or by current members to submit changes to
the information currently on file. For changes, you need only provide your
name and the information to be changed. |
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The proxy should be completed by a member who will
be unable to attend a membership meeting and would like to give their voting
power to another member who will be present at the meeting. The proxy must
be filed with the Association Secretary at least 48 hours prior to the
scheduled start of the meeting for which the proxy is given. Proxies
received less than 48 hours in advance of the meeting will be kept on file
but will not be counted. |
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An enrollment form must be submitted in order to activate your optical plan benefit
coverage. After completing the form, print it, sign and date it, then send
it via the city-grey mail or scan it and attach it to an email to your LAAPSA Benefits
Coordinator at the address below.
City Grey-Mail Email
Sgt. Randall Blayney RBlayney@LAAPSA.ORG
Van Nuys Airport Police
Mail Stop 102
- For Sergeants & Lieutenants - the "unique ID number" asked for on the
form is your department serial number followed by the last 4 digits of
your SSN.
- For Senior Safety Officers - the "unique ID number" asked for on the
form is your department serial number followed by the last 5 digits of
your SSN.
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This AD&D enrollment form is required to receive the free coverage provided
through our membership in PORAC. Your beneficiary will receive $10,000 if your
death was "on-duty" or $2,000 for "off-duty". Print and complete the form
including your signature and date. For the "free" coverage, put a check mark in
the box next to the "Core Plan". Send the completed and signed form to your Benefits
Coordinator by either method listed in the Spectera section above. |
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The first form is for new LAAPSA members to enroll in the $50,000 life insurance plan that is provided through PORAC at no cost to the member. This policy also provides $50,000 of AD&D coverage.
The second form is for members who want to apply for additional life insurance at their own cost.
Complete the forms on-line, print it, sign it, then return it to your Association Benefits Coordinator.
A copy of the PORAC $50,000 Life Insurance policy is available for download by clicking here. |
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New members who have not enrolled in the Long-Term Disability plan through PORAC must complete this application. Fill in the form on-line, print it, sign it, then return it to your Association Benefits Coordinator. |
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Accessing LAAPSA Forms |
LAAPSA forms are in PDF format and require Adobe Reader or Adobe Acrobat to view. If neither of these programs are currently installed on your computer, you may download a free copy of Adobe Reader by clicking on the link below and following the installation instructions.
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