United Falcons of UW River Falls/AFTW, Local 6504

I authorize (INSERT LOCAL NAME AND NUMBER) and American Federation of Teachers (AFT) to draft my account each month for the amount indicated above. The monthly dues amount include local, state, or national constitutions. If this happens, I authorize my bank to adjust my monthly payment when notified by (INSERT LOCAL NAME AND NUMBER). I agree this authorization remains in effect until terminated in writing by me. I understand that union dues may not be deductible for federal income tax purposes; however, under limited circumstances, dues may qualify as a business expense.

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