Pennsylvania Joint Board Voluntary Payroll Deduction Authorization

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I affirm my membership in Workers United and I hereby authorize and direct the payroll department of my employer, to deduct from my wages the sum of

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per week as voluntary contribution to the Workers United for Political Power Campaign Committee, (“Workers United for Political Power”) or any successor thereto, and the promptly transmit that sum to Workers United for Political Power (22 S 22nd St Philadelphia, PA 19103).

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I understand that Workers United for Political Power collects voluntary contributions from members and uses those contributions for political purposes, including, but not limited to supporting federal and state candidates and political committees. I also understand: (i) that contributions to Workers United for Political Power are voluntary; (ii) that making a contribution is neither a condition of employment nor membership in the Union; and (iii) the members have the right to refuse to contribute without reprisal. I understand that any contribution amount that the Union may suggest is only a guideline and that I may not contribute more or less than that amount without being favored or disadvantaged by the Union for doing so.

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Today’s Date

01/24/2026