Step 2 of 2: SEIU Committee on Political Education (COPE) Authorization

I want to help SEIU Local 1991 members have a political voice. Together we can advance healthcare issues important to working families.

We need to join together and contribute to our political fund (COPE) so that we can effectively:

Support local Commissioners and other candidates who stand up for Nurses, Doctors and Healthcare professionals and approve contracts;
Lobby statewide for Healthcare issues of importance to our members (Such as Safe Lifting, Safe Staffing and Special Risk Retirement);
Because we are prohibited from using our dues money for federal political contributions; and
Because politics are a critical part of winning good contracts and maintaining County, State and Federal funds to support quality patient care.

Contact Information

First Name Last Name

Personal Email

(Optional)

Additional Information

I hereby authorize my employer to deduct from my wages and pay SEIU Local 1991 Cope, the following amount per pay period:

$5 $10 $15 $25

Are you registered to vote? (Optional)

Yes No

Today's Date

I understand that I am not required to sign this form or make contributions to SEIU COPE as a condition of employment or membership in the union, and that I may decline to contribute without any reprisal. I understand that only union members and executive or administrative staff who are US citizens or lawful permanent residents are eligible to contribute to SEIU COPE, and that SEIU COPE uses the contributions it receives for political purposes, including but not limited to addressing political issues of public importance and contributing to, and spending money in connection with, federal, state and local elections.

Contributions from non-members will not be accepted, and will be returned.

Contributions to SEIU COPE are not tax deductible as charitable contributions for federal income tax purposes.

This authorization shall remain in effect unless revoked by me with 30 days written notice to both SEIU 1991 and my employer.

TOGETHER, WE CAN WIN FOR QUALITY CARE!

Signature