Hamtramck Federation of Teachers Local 1052

By providing the information on this form, I authorize the Hamtramck Federation of Teachers (HFT), AFT Michigan and AFT to deduct monthly dues for membership per the above information and in accordance with the HFT constitution, the AFT MI constitution and the AFT constitution. Dues payments are not deductible as charitable contributions for federal income tax purposes, but a portion thereof may be deductible as a miscellaneous itemized deduction. The monthly dues amount may change if authorized according to the requirements of the local, state or national constitutions. If this happens, I authorize my bank or credit card to adjust my monthly payment when notified by HFT or AFT MI. These deductions shall be made monthly per the above information and continue until HFT is given written notification of cancellation or termination of employment with your school district.

PAC DISCLOSURE LANGUAGE - I hereby authorize a monthly contribution to the AFT Michigan Political Action Committee (AFT MI PAC) in the amount indicated above. This authorization is made based on my specific understanding that: I am a U.S. citizen and/or legal permanent resident of the United States. This authorization is signed freely and voluntarily and not out of any fear of reprisal, and I will not be favored nor disadvantaged because I exercise this right. I understand this money will be used to make political contributions by AFT MI PAC. AFT MI PAC may engage in joint fundraising efforts with the AFT MI PAC, AFT/PAC and/or AFL-CIO. This voluntary authorization may be revoked at any time by notifying AFT MI PAC or the HFT in writing of the desire to do so. Any contribution guidelines or suggestions for giving are only suggestions. You may give more or less than the suggested amount. Contribution or gifts to AFT MI PAC are not deductible as charitable contributions for federal income tax purposes. Contributions cannot be reimbursed or otherwise paid by any other person or entity. Section 55(6) of the Michigan Campaign Finance Act provides that a corporation, a joint stock company, a domestic dependent sovereign, or a labor organization "may solicit or obtain contributions for a separate segregated fund established on an automatic basis, including but not limited to a payroll deduction plan, only if the individual who is contributing to the fund affirmatively consents to the contribution at least once in every calendar year".