TWU COPE
Automatic Deduction Form for: Railroad Division
(print page and fill out by hand)
COPE PAYROLL DEDUCTION AUTHORIZATION
RAILROAD DIVISION
TRANSPORT WORKERS UNION OF AMERICA AFL-CIO
1700 Broadway, 2nd Fl., New York, NY 10019
Employee's Identification # _____________________
Social Security # _________________________
Employee's Name __________________________________________
Print (Last/First/Middle Initial)
Employee's Home Address __________________________________________
(Street & Number/City/State/Zip Code)
I hereby authorize and direct my employer, ___________________________ to deduct from my pay the sum of $ _________ for each month in which compensation is due me, and to forward that amount to the Transport Workers Union of America--Committee On Political Education (COPE). This authorization is voluntarily made on the specific understanding that the signing of this authorization and the making of payments to the Transport Workers Union of America--Committee On Political Education (COPE) are not conditions of membership in the Union or of employment with the Carrier; is not a part of union dues or membership fee; and that the Transport Workers Union of America--Committee On Political Education (COPE) will use the money it receives to make political contributions and expenditures in connection with Federal, State and Local elections, as permitted by law. I understand that contributions or gifts to TWU-COPE are not deductible for federal income tax purposes.
It is understood that this authorization will remain in effect for a minimum of 12 months; and, thereafter, I may revoke this authorization at any time by giving the Carrier and the Union 30 days advance written notice of my desire to do so.
Signed at _____________________________________ Local No _________
This _______ day of ________________, 20_____
(Signature) __________________________________________
NOTE: This form must be given to your employer for processing and a copy sent to the TWU COPE Dept.
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