CHECK OFF FORM
SOUTHERN STATES MILLWRIGHT REGIONAL COUNCIL
Texas Political Committee
I, the undersigned, do voluntarily authorize the SSMRC, and/or the appropriate third-party agency/administrator, to deduct from my 4% working dues an amount equal to $0.05 (five cents) per each hour worked to be certified as a voluntary contribution to be paid to the treasurer of the SOUTHERN STATES MILLWRIGHTS REGIONAL COUNCIL (TEXAS) POLITICAL COMMITTEE (SSMRC-PC) to the extent permissible under the law.
My contribution is voluntary, and I fully understand these monies shall be utilized for the purpose and in the manner as prescribed in the Operating By-Laws for the SSMRC-PC, a copy of which will be made available upon my request.
The signing of this authorization form and the making of contributions to the SSMRC-PC are not conditions of membership in the union nor employment with an employer, and I may refuse to do so without fear of reprisal. I am making a voluntary contribution to fund-raising efforts sponsored by the SSMRC-PC. I understand that this contribution amount is only a suggestion, and I am free to contribute more or less than that amount and will not be favored or disadvantaged due to the amount of my contribution or refusal to contribute and that I may revoke this authorization at any time by giving written notice. SSMRC-PC will use my contributions for political purposes, including, but not limited to, the making of contributions or expenditures on behalf of candidates for non-federal offices and addressing political issues of public importance.