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Membership Form Instructions

You will need to download the forms, fill them in and then sign them.

File to download: Membership Form and Disability Card 2017.pdf

You may send your signed and filled-in form as an attachment to an email

Membership Form Instructions (White Top Form)

The top of the white form most blanks are obvious.  Here is help on a couple of tricky ones.

  1. Signature – there are two places for signature – be sure to sign both (top and bottom of form).
  2. Personal Email. This is important.  This is the only way to reach you should CLC not allow us to use CLC email for some reason.
  3. School Building is “CLC”

The second part of the white form is a voluntary donation to the local PAC fund.

  1. Paragraph 1 – School District is College of Lake County District 532
  2. Paragraph 2 – “An additional twenty dollars . . .” Most adjuncts give $20 (it’s a one-time donation) and is automatically deducted only once a year,  but you can put zero or any amount you want. This supports local elections for education-friendly candidates and school boards.

Accidental Death and Dismemberment Card (Pink Card)

The pink card is for Accidental Death and Dismemberment policy – the amount is not large (it was $25,000) but it comes free as a benefit for being a member of CLC-AFO.

Return Options

  • Email – You will need to scan the signed form and email it as an attachment to any of the people listed below.
  • Intercampus Mail – You can send the form via intercampus mail to any officer listed below.
  • Questions call Karen Florian: (847) 543-2000 ext 32601


Karen Florian President (EMPS)

Lynette Thornburgh Secretary (BIO)

Jessica Hoth Treasurer (EMPS)

Local 504 Membership

Betty McCann