C.O.P.E. Reg Form

Support the Union’s Committee on Political Education (COPE)

C.O.P.E Registration form

 

I hereby authorize the Cerritos Community College District to deduct from my

salary the sum of   _____ ($10), ______($15), ________ ($25),  or $ ___________ (any other amount) per pay period and forward that amount to Cerritos College Faculty Federation, Committee on Political Education (COPE).

Member: please print your name and sign and date as indicated below. Please return this form via inter-campus mail to either COPE Chair Dennis Falcon or Treasurer Mike Farina.

This authorization is signed freely and voluntarily and not out of any fear of reprisal and I will not be favored or disadvantaged because I exercise this right. I understand this money will be used by AFT/COPE to make political contributions. This voluntary authorization may be revoked at any time by notifying Cerritos College Faculty Federation, Committee on Political Education (COPE) Chair, Dennis Falcon at proffalcon1984@gmail.com or Treasurer, Mike Farina at mfarinacpa@hotmail.com and submitting a written notice. Contributions or gifts to AFT/COPE are not deductible as charitable contributions for federal income tax purpose.

 

Print Name_____________________________________________________

 

Signature_______________________________________________________

 

Date____________________________________