PAC AUTHORIZATION

By selecting a dollar amount below, I hereby authorize my employer to withhold the indicated amount per pay period to forward to PASNAP as a contribution to the PASNAP Political Action Committee (“PASNAP PAC”).

I make this authorization voluntarily with the understanding that:

1. I am not required to sign this form or make voluntary contributions to PASNAP PAC as a condition of my employment or membership in the union;

2. I may refuse to contribute without reprisal;

3. Under law, only union members and executive/administrative staff who are U.S. Citizens or lawful permanent residents are eligible to contribute to PAC;

4. The contribution amounts on this form are merely suggestions, and I may contribute more or less by this or other means without fear or favor or disadvantage from PASNAP or my employer;

5. PASNAP PAC uses the money it receives for political purposes - including, but limited to, making contributions to and expenditures on behalf of candidates for federal, state, and local offices - and addressing political issues of public importance.

This authorization shall remain in effect until revoked by me in writing to PASNAP.