YES! I want to be part of something bigger and contribute the Colorado Wins COPE fund.

I am ready to build power with other Colorado State Employees by contributing to the COPE Fund

Contact Information

First Name Middle Name (Optional) Last Name

Street Address (Optional) Address Line 2 (Optional)

Postal Code (Optional) City (Optional) State/Province (Optional)

Personal Email (no work emails) Home Phone (Optional) Mobile Phone (Optional)

By providing my phone number, I understand that SEIU and its locals and affiliates may use automated calling technologies and/or text message me on my cellular phone on a periodic basis. SEIU will never charge for text message alerts. Carrier message and data rates may apply to such alerts. Text STOP to 787753 to stop receiving messages. Text HELP to 787753 for more information.

Employer

(Optional)

______

Employee Number (Optional)

COPE Authorization: Hold politicians accountable

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 to withhold the indicated amount per month to forward to SEIU Local and its successors and assigns (hereinafter “Colorado WINS") as a contribution to SEIU Committee on Political Education (“SEIU COPE”) and AFT Committee on Political Education (“AFT COPE”). My signature shows that I agree with the terms below.

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 or AFT 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 SEIU COPE or AFT 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 of favor or disadvantage from SEIU or my employer; 5) SEIU COPE and AFT 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; (6) I understand that my contribution will be allocated 75% to SEIU COPE and 25% to AFT COPE, and that I am free to change this allocation by informing Colorado WINS in writing; and (7) I understand that AFT COPE may engage in joint fundraising efforts with the AFL-CIO. This authorization shall remain in effect until revoked by me in writing via U.S. mail to Colorado WINS Local 1876.

Do you want to contribute to COPE? If so, how much?

If you selected "other" for COPE, how much would you like to contribue? (Optional)

Please type your full name to be used as your digital signature

Contributions or gifts to SEIU COPE and AFT COPE are not tax deductible. Federal law requires SEIU COPE and AFT COPE each to use its best efforts collect and report the name, mailing address, occupation and name of employer of individuals whose contributions exceed $200 in a calendar year.

Signature