HCII Indiana Hoosier PAC

I hereby authorize my employer to withhold the indicated amount each pay period to forward to SEIU Healthcare Illinois & Indiana and its successors or assigns (collectively “HCII”) as a contribution to SEIU Healthcare Indiana Hoosier PAC (“PAC”). My signature shows that I agree with the terms below.

By providing my phone number, I understand that SEIU and its locals and affiliates may use automated calling technologies and/or text message me on my cellular phone on a periodic basis. SEIU will never charge for text message alerts. Carrier message and data rates may apply to such alerts. Text STOP to 787753 to stop receiving messages. Text HELP to 787753 for more information.

PAC 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 PAC 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 PAC; 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 HCII or my employer; 5) PAC 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 HCII.

Contributions or gifts to PAC are not tax deductible as charitable contributions.