WE ARE THE CLASSIFIED EMPLOYEES OF PCC

I hereby request and voluntarily authorize my employer to deduct from my wages an amount equal to the regular monthly dues uniformly applicable to members of PCCFCE, and further that such amount so deducted be sent to PCCFCE for and on my behalf. This authorization shall remain in effect and shall be irrevocable for a period of one year from the date of this authorization and shall be renewed from year to year thereafter, irrespective of my membership in PCCFCE, unless I notify both my employer and PCCFCE in writing, with my valid signature, of my desire to revoke this authorization between April 21 and May 20.

While contributions or gifts to PCCFCE are not tax-deductible as charitable contributions for federal income tax purposes, they may be tax- deductible under other provisions of the Internal Revenue Code. The invalidity or unenforceability of any particular provision hereof shall not affect the other provisions, and this agreement shall be construed in all respects as if such invalid or unenforceable provision were omitted.

By signing and submitting this form, it shows that I agree with the terms above.

This contribution may qualify for the Oregon Political Tax Credit. Qualifying single filers are eligible for a credit of $50/year; qualifying joint filers $100/year. AFT-Oregon Political Action Fund DISCLOSURE: I hereby authorize a monthly contribution to the AFT-Oregon Political Action Fund in the amount indicated above. 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. AFT-Oregon Political Action Fund may engage in joint fundraising efforts with AFT COPE and/or the AFL‐CIO. This voluntary authorization may be revoked at any time by notifying AFT-Oregon Political Action Fund in writing of the desire to do so. Contribution or gifts to AFT-Oregon Political Action Fund are not deductible as charitable contributions for federal income tax purposes. Contributions cannot be reimbursed or otherwise paid by any other person or entity.