Active Ballot Club
Join the fight NOW, to secure legislation that will provide premium pay to the essential workers TOMORROW!

AUTHORIZATION FOR UFCW POLITICAL CHECKOFF
I hereby authorize my employer to deduct an additional *
Required
per week from my paycheck as a contribution to the UFCW Active Ballot Club Political Action Committee. I understand that any guideline contribution amount is merely a suggestion and that I am free to contribute more or less, and the union will not favor or disadvantage me by reason of the amount I contribute or my decision not to contribute. I understand that my contributions will be used for political purposes, including the support of candidates for federal, state and local office, and speaking out on public issues. Contributions to the UFCW Active Ballot Club Political Action Committee are not deductible for federal income tax purposes.
Date *
Last 4 of SSN *
First Name *
Last Name *
Workplace and Unit # *
Email *
Address *
Cell *
Please type your FULL NAME as an E-Signature *
By providing your cell phone number, I consent to receiving informational, non-commercial text messages from UFCW, while reserving the right to opt out in the future. Federal law requires us to use our best efforts to collect report the name, mailing address, occupation and name of employer of individuals whose contributions exceed $200 in a calendar year.
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