Cope – Vacation/Holiday Check-off Authorization

I hereby authorize and direct (check one)
- Electrus Federal Credit Union
- MN Building Trades Federal Credit Union
To deduct from my vacation/holiday fund account per month*
- $10
- $20
- $50
Amount per month to the IBEW, Local Union 292, Voluntary Political Education Fund.
Name
First Last
Social Security # or Credit Union Account #*
- Last 4 Numbers of Social Security #
- Credit Union Account #
Last 4 Numbers of Social Security #*
Credit Union #*
Authorization*
I agree to the authorization.
This authorization is voluntarily made based upon my specific understanding that the signing of this authorization card and he making of these voluntary contributions are not conditions of membership in the union or of employment by my employer; that I may refuse to contribute without reprisal; and that Local Union 292, IBEW, use the money they receive for political purposes, including but not limited to making contributions to and expenditures for candidates for Federal, state and local offices.

The authorization shall remain in full force and effect until revoked in writing by me.
Signature*
Authorized by the IBEW on behalf of a fund-raising effort for Local Union 292, Voluntary Political Education Fund.