Enrollment Form for Legal Club's Family Protection Plan

HOW TO ENROLL in three easy steps:

  • Complete the Member and Affiliation Information below
  • Choose your plan
  • Click the ENROLL button

You can review the benefits of each plan by clicking on the plan name here:

Family Protection Plan Classic Family Protection Plan Family Protection Plan PLUS

Once you have submitted this enrollment form, you may contact Legal Club to use the plan immediately. Contact Member Services at (800) 305-6816 to receive an attorney referral or access to your other plan benefits.


Member Information:

   * Required    
* First Name:
* Last Name:
Middle Initial:
* Date of Birth:
* SSN:
* Member ID #:
   
* Home Address 1:
Home Address 2:
* City:
* State:
* Zip Code:
   
* Home Phone:
* Work Phone:
* Email Address:
   
* Affiliation: I am an active member of CSUEU
I am an active member of ACSS
I am an active member of SEIU Local 1000
I am an active member of CA State Retirees
   
* Choose Your Plan: Family Protection Plan Classic - $14 per month
Family Protection Plan - $16 per month
Family Protection Plan PLUS - $20 per month
 
Enrollment Terms:
YES, I want to take advantage of this special offer of membership in the Legal Club discount legal services program and receive access to all the services and benefits outlined. I understand that the fees and charges sought by the participating plan attorneys may only change if posted to the Legal Club Web site. Legal Club and its agents are not party to any confidential attorney/client relationship that I may establish. I understand that this plan is not an insurance coverage. I understand that I may not use the plan and any of its attorneys to adversely affect my employer or plan sponsor. Upon enrollment, I have thirty (30) days to cancel my membership. The annual membership shall automatically renew unless terminated thirty (30) days prior to the expiration date of the term. I also understand my Legal Club membership will continue as long as payments are received, unless explicitly cancelled.
 
Payroll Deduction Terms:
I hereby enroll for a legal plan offered through Legal Club. I am either an active member of CSEA or I am a retiree. I understand that if I am an active member of CSEA, the State of California will deduct the premium for Legal Club from my salary or wages. I understand that if I am a retiree, the Public Employees Retirement System will deduct the premium for Legal Club from my retirement allowance.
 

By clicking the Enroll button below I agree to the selections I made above and have read and accept the Enrollment and Payroll Deduction Terms.