Local 23 TIP Authorization (Members Only)

Local 23 TIP Campaign Authorization
EMPLOYER*
NAME*

First NameLast Name
CELL PHONE*
Home Phone
Email
Enter your email address to receive a copy of your authorization.
Date of Hire

MonthDayYear
Date
Text Opt In

Opt In to receive important union communications via text messaging. Message and Data Rates May Apply. Expect approx. 3-4 msgs/month. To opt-out text STOP to 88789. Terms of use at http://help.mcommons.com/s/88789. For more information text HELP to 88789, or email local23@unitehere.org. For the Union’s privacy policy, see www.unitehere.org/privacy-policy.
SOCIAL SECURITY NUMBER (no hyphens)*
TIP Authorization

I hereby authorize the Employer to deduct from my pay the sum indicated below and to forward that amount to the UNITE HERE TIP Campaign Committee. This authorization is signed voluntarily and with the understanding that the UNITE HERE TIP Campaign Committee will use this money to make political contributions and expenditures in connection with Federal elections. I am aware of my right to refuse to sign the authorization without reprisal. This authorization may be revoked by mailing notices of revocation by United States Registered or Certified Mail, Return Receipt Requested, to UNITEHERE International Union, Attn: Zaina Tanu-Kahn, Political Director, 275 7th Ave, New York NY 10001-6708.
Weekly Deduction (USD$)*
Signature*

Clear
Today's Date

MonthDayYear
Date
Email2
example@example.com
Should be Empty:

Local 23 TIP Campaign Authorization