Pol - COPE form

Committee On Political Education: Standing up for working families!

Para español, haga clic en la bandera a la derecha del título.
SEIU 49 members are committed to social and economic justice. We work hard to campaign for candidates and pass laws that improve the lives of working families in our region and around the country.

Through small, voluntary contributions to Committee On Political Education (COPE), SEIU members have created a strong voice for working people in our State Capitols. COPE allows us to have a direct impact on key issues in our communities such as good jobs, affordable housing and paid family leave.
I authorize my employer to deduct [select one] per month for the SEIU Local 49 Political Action Fund (PAF/COPE).*

$20$15$10Other (no more $20)
Name*

First NameLast Name
Date*

MonthDayYear
Date
Employer*
Birthdate*

MonthDayYear
Date
Your zip code*
I understand that 1) I am not required to sign this form or make PAF/COPE contributions as a condition of my employment by my employer or membership in the union; 2) I may choose not to contribute without any reprisal; 3) only SEIU members and union executive/administrative staff and only US citizens or legal permanent residents are eligible to contribute to SEIU PAF/COPE; 4) the amounts on this form are suggestions, and I may contribute more or less by other means without fear of favor or disadvantage from my employer or the union; 5) SEIU PAF/COPE uses the money for political purposes, including but not limited to, addressing political issues that impact working families and by contributing to and spending money in connection with federal, state and local elections. This authorization shall remain in effect until discontinued in writing by me. My signature on this form shows that I have read and agree with these terms.*

Clear
Should be Empty:

Committee On Political Education: Standing up for working families!