APPENDIX B

MEMBERSHIP APPLICATION

AUTHORIZATION FOR DEDUCTION OF ASSOCIATION DUES
ALBUQUERQUE SECRETARIAL/CLRICAL ASSOCIATION

________________________________________________________
Last Name                                                         First Name and Initial

_________________________________     __________________________
Home Address                                                  Home Telephone Number

Number of Days Worked Per Year:_________  Employee Number_________

Name of Work Site______________________ Work Location____________

I hereby authorize APS to deduct from the compensation due me one (1) deduction from each of the 24 paychecks representing ASCA due in the amount certified to the APS Board, in writing, by ASCA and remit same to ASCA. Payroll deductions will continue unless revoked in writing by me to ASCA and APS payroll office not later than 30 days prior to the effective date of revocation. The APS Board assumes no responsibility in connection with this authorized deduction except to act as remitting agent in forwarding the amount deducted to ASCA.

____________________________________________   _________________
Signature of Employee Authorizing Deduction                    Date
 

The ASCA Committee on Political Action collects voluntary contributions for distribution to federal, state and local political candidates who support ASCA’s legislative goals. Membership in good standing with ASCA is not dependent upon your decision to contribute or not contribute to ASCA COPE.

___________________________________________    __________________
Signature of Employee Authorizing COPE Deduction        Date

Dues paid to ASCA may not be deductible for Federal Income Tax purposes; however, under limited circumstances, dues may qualify as a business expense. Contributions of COPE or other purposes to ASCA are not deductible as charitable contributions for Federal Income Tax purposes.
 

APPENDIX B