United Faculty and Academic Staff (UFAS) Local 223

By providing the information on this form, I authorize United Faculty Academic Staff - Local 00223 and the American Federation of Teachers (AFT) to deduct dues for membership per the above information and in accordance with the United Faculty Academic Staff - Local 00223 constitution, the state 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 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 payment when notified by United Faculty Academic Staff - Local 00223. I agree this authorization remains in effect until terminated in writing by me or until United Faculty Academic Staff - Local 00223 is given written notification of my separation from my employer and/or the bargaining unit.

COPE DISCLOSURE: I hereby authorize a monthly contribution to the COPE 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. COPE 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 COPE in writing of the desire to do so. Contribution or gifts to COPE are not deductible as charitable contributions for federal income tax purposes. Contributions cannot be reimbursed or otherwise paid by any other person or entity.