Teamsters Local 500

POLITICAL ACTION FORM Request

I subscribe the sum of $2.00 per week to TEAMSTERS LOCAL No. 500 POLITICAL ACTION FUND with the understanding that this voluntary contribution may be used for political purposes. I further hereby authorize and

request my employer to deduct from my earnings the sum of $2.00 per week during any payroll period to be remitted to TEAMSTERS LOCAL No. 500 POLITICAL ACTION FUND. I reserve the right in accordance with the applicable State or Federal laws to revoke this authorization at any time by giving written notice of such revocation to TEAMSTERS LOCAL No. 500 POLITICAL ACTION FUND in accordance with such laws or otherwise.

Fill out this form and submit it and we will send you an Application to join our Political Action Committee Fund

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