SEIU Local 721 COPE - Join SEIU.org

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Hold Politicians Accountable. Together we can build a stronger economy and win good middle-class jobs. Each of us can play a part. Join your fellow members in contributing to COPE to make sure your voice is heard.

Yes! I want to hold politicians accountable to working families and I know we can only do that if we stand together. I hereby authorize my employer to withhold the indicated amount per paycheck to forward to SEIU Local and its successors and assigns (hereinafter “Local 721”) as a contribution to SEIU Committee on Political Education (“SEIU COPE”).

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I voluntarily authorize my employer to deduct:*

$15 per pay period

$10 per pay period

$5 per pay period

every pay period from my paycheck and transfer the funds to SEIU Local 721 COPE. My signature shows that I have reviewed and agree with the terms of this form.

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 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 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 or my employer; 5) SEIU COPE uses the money it receives 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 Local 721 (or other method if permitted by Local 721’s policies). This authorization will remain effective if my employment with the Employer ends and I am later re-employed by the Employer. Contributions or gifts to SEIU COPE are not tax deductible as charitable contributions.

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Today’s Date

01/24/2026