SEIU 775

Basic Information



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Yes! I want to hold politicians accountable to working families and I know we can only do that if we stand together. I hereby authorize my employer, or the agent designated by the Union, subject to Section 3(“Plan for the Future”), to withhold the indicated amount per month to forward to SEIU 775 (“Union”) as a contribution to SEIU Committee on Political Education (“SEIU COPE”). If I don’t choose one of the amounts below, or write in a different amount, I agree to a $10.00 per month deduction. My signature shows that I agree with the terms below.

Other amount: $

In the event my employer, its agent, an agent designated by me or an agent designated by the Union, ceases my COPE contributions via payroll deduction, I hereby authorize SEIU to initiate a recurring, automatic electronic funds transfer with my financial institution beginning on the date listed in the transition notice provided to me in order to deduct from the account designated above in Section 4 (“Protecting The Future”) the dollar amount checked or designated below (or $10.00 if I fail to check a box or designate an amount) on the day after the first payday of the month designated by my employer and to transmit to SEIU as a contribution to SEIU Committee on Political Education (“SEIU COPE”).

This authorization is made voluntarily based on my specific understanding that: (1) I am not required to sign this form or make voluntary contributions to SEIU COPE as a condition of my employment or membership in the union; (2) I may refuse to contribute without reprisal; (3) Under law, only union members and executive/administrative staff who are U.S. Citizens or lawful permanent residents are eligible to contribute to COPE; (4) the contribution amounts on this form are merely suggestions, and I may contribute more or less by this or other means without fear or disadvantage from SEIU or my employer; (5) SEIU COPE uses the money it receives for political purposes – including, but not limited to, making contributions to and expenditures on behalf of candidates for federal, state, and local offices – and addressing political issues of public importance. This authorization shall remain in effect until revoked by me in writing to SEIU via U.S. mail.

Contributions or gifts to SEIU COPE are not tax deductible as charitable contributions.

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X 06/14/2021