COPE SIGN-UP

I voluntarily authorize and direct my employer and any successor employer (Employer) to deduct from my pay the indicated sum per week: $3.00 $5.00 $2.50 and remit that amount to the Amalgamated Transit Union Committee on Political Education (ATU COPE This authorization and direction is voluntarily made by me; it is not a condition of membership in the Amalgamated Transit Union (ATU) or any affiliated local union, or a condition of employment with my Employer. I may refuse to contribute without any reprisal. I understand that the amounts listed above are merely suggestions, I am free to contribute more or less than these guidelines and ATU will not favor or disadvantage me by reason of the amount of my contribution or my decision not to contribute. ATU COPE will use my contributions to make political contributions and expenditures, including but not limited to, in connection with federal, state and local elections. This authorization may be revoked at any time by notifying my local union or ATU COPE in writing of my desire to do SO.

Signature

Name:

Name*

Payment to cope per week*

Employee IDBadge Number*

Work Location*

Contributions to ATU COPE are not deductible as charitable contributions for Federal income tax purposes. Federal law requires us to use our best efforts to collect and report the names, mailing address, occupation and name of employer of individuals whose contributions exceed $200 in a calendar year.

Signature*