I hereby authorize and direct my employer to deduct the sums indicated above from my paycheck each pay period and forward them to the Local 338 RWDSU/UFCW Political Action Committee. I do so with the understanding that:

1. The signing of this authorization and the making of these voluntary contributions are not conditions of membership in Local 338 RWDSU/UFCW or of continuing employment with my employer.
2. I may refuse to contribute without reprisal from Local 338 or my employer.
3. Contributions or gifts to the Local 338 RWDSU/UFCW PAC are not tax deductible.
4. The Local 338 PAC will use the voluntary contributions it receives for political purposes, including but not limited to making contributions to and expenditures for candidates for state and local offices and addressing political issues of public importance.
5. This authorization shall remain in full force and effect until revoked by me in writing.
6. I am certifying that I am either a United States citizen or a permanent resident.

By clicking this "Submit" button I am attesting to the truthfulness of the statements on this form, that I am the person listed on this form, that I am authorizing the deduction of the amounts so indicated by me and their forwarding by my employer to the Local 338 RWDSU/UFCW PAC, and that it is my intent to electronically sign this authorization as the legal equivalent of having placed my handwritten signature on the authorization document being submitted to my employer and the PAC.