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HEAT AND FROST INSULATORS
POLITICAL ACTION COMMITTEE AUTHORIZATION FOR POLITICAL CONTRIBUTION
 
* Required Information
I hereby authorize my employer to deduct 16 cent(s) per hour from my wages and forward that amount to the Heat and Frost Insulators Political Action Committee. This authorization is signed voluntarily and not our of any fear of reprisal and with the understanding that the International Associate of Heat and Frost Insulators and Allied Workers will use the money to make political contributions and expenditures connected with federal, state and local elections and that this voluntary authorization can be revoked at any time by notifying my employer and the Heat and Frost Insulators Political Action Committee of my desire to do so. Contributions or gifts to the Heat and Frost Insulators Political Action Committee are not deductible as charitable contributions for federal income tax purposes.
 
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  Please type your name above as it appears on your Social Security Records.
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