The undersigned authorizes to deduct from each of my regular paychecks (or from one paycheck as directed at a specific time) the sum of _________ and to forward that amount to VOTE-COPE, c/o NYSUT, 800 Troy-Schenectady Road, Latham, NY 12110. I understand that this designated amount will continue to be deducted until revoked by me in writing.

NYSUT will not disadvantage anyone by reason of the amount of their contribution or decision not to contribute. Contributing to VOTE-COPE is voluntary, and NYSUT members may refuse to contribute to VOTE-COPE without reprisal. Contributing to VOTE-COPE is not a condition of membership in any labor organization. VOTE-COPE may use the money it receives to make political contributions and expenditures in connection with federal, state and local elections.

I expressly acknowledge and understand that the deduction, as specified above, be withheld from each of my regular paychecks. I hereby certify that I am a member of NYSUT, an employee organization entitled to receive union deduction payments as provided by law.

Federal law prohibits soliciting contributions from outside the restricted class and any such contributions will be returned to the contributor.

Only U.S. citizens or lawful permanent residents may contribute to NYSUT VOTE/COPE.