CEIU 511 Committee on Political Education (COPE) "*" indicates required fields URLThis field is for validation purposes and should be left unchanged.We Are Stronger Together! Join us for a stronger voice in our communities. I authorize my employer to deduct from my pay the sum of (selected amount) from my biweekly compensation and transmit that amount to CEUI Local 511 COPE.I authorize my employer to deduct from my pay the sum of:* $5 $10 $20 Other Amount Other Amount*First Name*Middle NameLast Name*Date of BirthStreet Address*City*Zip Code*State*– State –AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificMobile Phone*Email* Employee #By submitting your cell phone number you are agreeing to receive periodic text messages from this organization. Message and data rates may apply. Text HELP for more information. Text STOP to stop receiving messages.COPE Authorization This authorization is made voluntarily based on my specific understanding that: 1) I am not required to sign this form or make voluntary contributions to SEIU COPE or CEUI Local 511 COPE as a condition of my employment or membership in the union; 2) I may refuse to contribute without reprisal; 3) Under law, only union members and executive/administrative staff who are U.S. citizens or lawful permanent residents are eligible to contribute to SEIU COPE or CEUI Local 511 COPE; 4) The contribution amounts on this form are merely suggestions, and I may contribute more or less by this or other means without fear of favor or disadvantage from SEIU, CEUI Local 511, or my employer; 5) SEIU COPE and CEUI Local 511 COPE use the money they receive for political purposes—including, but not limited to, making contributions to and expenditures on behalf of candidates for federal, state, and local offices—and addressing political issues of public importance. This authorization shall remain in effect until revoked by me in writing via U.S. mail to SEIU or CEUI Local 511. Contributions or gifts to SEIU COPE or CEUI Local 511 COPE are not tax deductible as charitable contributions.Signature*
