PROTEC17 - PAC Donation Form

PAC Donation FORM

Sign up for voluntary donations to the PROTEC17 Political Action Committee (PAC) by filling out this form authorizing payroll deduction.

Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Employer*
Job Title/Classification*
I want to support the Political Action Committee!
I am least 18 years old. I am a U.S. citizen or lawfully permitted resident (i.e., green card holder) I am making these contributions from my own funds, and funds are not being provided by another person or entity for the purpose of making these contributions. I am not a foreign national nor are these contributions financed in any part by a foreign national, and no foreign national was involved in making decisions regarding these contributions in any way. I am not a federal contractor I am not a registered Federal lobbyist I am not a registered foreign agent.*
Yes, I recognize the need to contribute to political candidates in Washington state who support working families and their issues. I understand that I am voluntarily contributing to the separate PROTEC17 Political Action Committee (PAC) fund and that my union dues money never goes to the endorsement of political candidates. I understand that my contributions to the PAC are not deductible for federal income tax purposes. I also certify that the following statements are true and agree to these contribution rules. This certification shall apply to each contribution I make and remain in effect until revoked in writing via U.S. mail to PROTEC17.
I am least 18 years old.

I am a U.S. citizen or lawfully permitted resident (i.e., green card holder)

I am making these contributions from my own funds, and funds are not being provided by another person or entity for the purpose of making these contributions.

I am not a foreign national nor are these contributions financed in any part by a foreign national, and no foreign national was involved in making decisions regarding these contributions in any way.

I am not a federal contractor

I am not a registered Federal lobbyist

I am not a registered foreign agent.

Signature*

Date Signed*

I hereby authorize my employer to deduct (select one below) $7 $17 $27 $37 $47 or another amount every paycheck to make political contributions to the Professional and Technical Employees Local 17 (PROTEC17) PAC. This authorization remains in effect until revoked in writing by me.

PAC Donation Amount*

Signature*

Date Signed*

No employer or labor organization may discriminate against an officer or employee in the terms or conditions of employment for (a) the failure to contribute to, (b) the failure in any way to support or oppose, or (c) in any way supporting or opposing a candidate, ballot proposition, political party, or political committee you for contributing or not contributing to a political committee, or supporting or opposing a candidate, ballot measure or political party.

PAC Donation FORM

I want to support the Political Action Committee!