Cope Contribution

I understand that: 1) I am not required to sign this form or make COPE contributions as a condition of my employment by my employer or membership in the union; 2) I may refuse to contribute without any reprisal; 3) Only union members and executive/administrative staff who are U.S. Citizens or lawful permanent residents are eligible to contribute to SEIU Local 721 COPE; 4) The amounts on this form are merely a suggestion, and I may contribute more or less by this or some other means without fear of favor or disadvantage from the union or my employer, 5) SEIU Local 721 COPE uses the money it receives for political purposes, including but not limited to addressing political issues of public importance and contributing to and spending money in connection with federal, state and local elections. Contributions to SEIU Local 721 COPE are not deductible for federal income tax purposes. This authorization shall remain in effect until revoked in writing by me. I authorize my employer to deduct my contribution every month from my paycheck and transfer the funds to SEIU Local 721 COPE. My signature shows that I have reviewed and agree with the terms on this form.