SCRANTON FEDERATION OF TEACHERS

VOLUNTARY C.O.P.E. CONTRIBUTIONS

I hereby authorize and direct the School District of the City of Scranton to deduct from my earnings the following amount as my voluntary contribution to the S.F.T.-C.O.P.E. account. This deduction as indicated below shall be made each payday (twenty-six times per year) and each deduction is to be forwarded to the Secretary/Treasurer of the Scranton Federation of Teachers within thirty days of the date it is deducted.

[]$5.00[] $4.00 [] $3.00 [] $2.00 [] Other $_______

This authorization is signed freely and voluntarily and not out of any fear of reprisal and I will not be favored or disadvantaged because I exercise this right. I understand this money will be used to make political contributions by AFT/COPE. AFT/COPE may engage in joint fundraising efforts with the AFL-CIO. This voluntary authorization may be revoked at any time by notifying the S.F.T.-C.O.P.E. Committee in writing of the desire to do so.

Print Name ________________________________________________

Signature___________________________________

Date______________

School________________________________________

Contributions to AFT/COPE or S.F.T.-C.O.P.E. are not deductible as charitable contributions for federal income tax purposes.