By checking the box above and clicking the 'Submit' button, I state that I have reviewed and agree with the terms set forth below: This authorization is made voluntarily based on my specific understanding that: I am not required to fill out this form or make SEIU Local 121RN Committee on Political Education (COPE) contributions as a condition of my employment or membership in the union; I may refuse to contribute without any reprisal; only union members and executive/administrative staff who are U.S. citizens or legal U.S. residents are eligible to contribute to SEIU COPE. The amounts on this form are merely a suggestion, and I may contribute more or less by this or some other means without fear of favor or disadvantage from the union. SEIU COPE uses the money it receives for political purposes, including but not limited to addressing political issues of public importance and spending money in connection with federal, state and local elections. This authorization shall remain in full force and effect until revoked in writing by me via U.S. Mail. By clicking the "Submit" button, I state that I have reviewed and agreed with the terms stated here. Contributions or gifts to SEIU COPE are not tax deductible as charitable contributions.