Page 17 - NMO State

Yours Free! When You Contribute $1.93 a week* ($8.35 monthly) or more to PEOPLE. It’s the perfect way to show that you’re working to save our pension and health benefits! *Based on 52 weeks
What is PEOPLE?
CSEA’s PEOPLE Program protects and improves our jobs, benefits and pensions in Washington, Albany and in your community. Your support and participation in PEOPLE strengthens CSEA’s clout in the workplace, in the legislature, in your community and in the labor movement.
Join People Today!
Our Green Jacket - Available Only to MVP PEOPLE Members
Please complete the enclosed application form, return
it and we will send you
your FREE jacket.
Please allow 6 to 8 weeks for delivery.
Members that contribute $100.00 or more annually will be enrolled in the PEOPLE Membership Rewards Program.
YES! I want to be part of the action. * Voluntary PEOPLE Membership Authorization * Payroll Deduction Application
Total amount deducted per year in equal installments:
¨$500 ¨$250 ¨$100 MVP ¨$______ Other
In addition to my Civil Service Employees Association, Inc., dues deduction previously authorized by me, I further authorize the State of New York or associated agencies to deduct annually the PEOPLE deduction amount checked and remit to the Civil Service Employees Association, Inc., as a voluntary contribution to be forwarded to the Treasurer of the PEOPLE Qualified Committee, AFSCME, P.O. Box 65334, Washington, DC 20035-5334, to be used for the purpose of making political contributions and expenditures. My contribution is voluntary, and I understand that it is not required as a condition of membership in any organization, or as a condition of continued employment, and is free of reprisal. I understand that any contribution guideline 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.
_________________________________________________________ SIGNATURE DATE
Circle size: X-small / S / M / L / XL / 2XL / 3XL / 4XL ¨Jacket Received
Recruiter: ___________________________________________
Name ________________________________________________
Last First Middle
Address _____________________________ Apt. # / Floor______ City ___________________________State _____ ZIP _________
CSEA ID No. __________________________________________
Work Phone ( ) __________ Home Phone ( ) ____________
Job Title ______________________________________________
Employer _____________________________________________
Region _______ Local _______ Unit _______ Pay Periods ______
Email address __________________________________________
NOTE: In accordance with federal law, AFSCME PEOPLE will accept contributions only from members of AFSCME and their families. Contributions or gifts to AFSCME PEOPLE are not deductible as charitable contributions for federal income tax purposes.
YES! I want to be part of the action. * Voluntary PEOPLE Membership Authorization * Direct Contribution Authorization
¨Enclosed is my personal check or money order made payable to Last First Middle PEOPLE in the amount of:
Name ________________________________________________ Address _____________________________ Apt. # / Floor______
City ___________________________State _____ ZIP _________ CSEA ID No. __________________________________________
Work Phone ( ) __________ Home Phone ( ) ____________ Job Title ______________________________________________ Employer _____________________________________________ Region _______ Local _______ Unit _______ Pay Periods ______ Email address __________________________________________
NOTE: In accordance with federal law, AFSCME PEOPLE will accept contributions only from members of AFSCME and their families. Contributions or gifts to AFSCME PEOPLE are not deductible as charitable contributions for federal income tax purposes.
¨$500 ¨$250 ¨$100 MVP ¨$______ Other or
¨Credit Card Contribution (I hereby authorize AFSCME PEOPLE to bill my credit card account listed in the amount of $ ___________ monthly or a one-time yearly contribution of $ ___________. This authorization will remain in effect until written notice of termination is given to AFSCME PEOPLE.
Name on Card _____________________________________________ Expiration Date _____________________________________________
¨VISA ¨MASTERCARD ¨DISCOVER CARD
Card Number ______________________________________________
3 or 4 digit security code (back of card) __________________________
__________________________________________________________ SIGNATURE DATE
Circle size: X-small / S / M / L / XL / 2XL / 3XL / 4XL ¨Jacket Received
Recruiter: _____________________________________________