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D.R.I.V.E. Form

Optional Contribution

I want to hold politicians accountable to working families. I authorize my employer to withhold the amount below each week to forward to the local union as a contribution to D.R.I.V.E. (Democratic Republican Independent Voter Education). I subscribe, freely and voluntarily, the sum indicated below each week to DRIVE with the understanding that this voluntary contribution may be used by DRIVE for political purposes consistent with the labor-related goals of DRIVE, including contributions to support candidates for local, state and federal offices. I understand my right to refuse to contribute or to discontinue this contribution without reprisal and that the amounts below serve merely as suggestions. I am free to subscribe more or less than these guidelines, or nothing, without benefit or disadvantage to my employment status. I further hereby authorize and request my employer to deduct from my earnings the sum indicated below each week to be remitted to National DRIVE. I reserve the right in accordance with the applicable state or federal laws to revoke this voluntary authorization at any time by giving written notice of such revocation to National DRIVE in accordance with such laws or otherwise.

First Name *

Last Name *

Postal Code *

Last 4 SSN *

DRIVE Amount *

(Minimum $1 a week or none at all)

Employer *

Enter Employer Name

Authorize DRIVE *

Yes, I wish to donate to DRIVE. BY SIGNING THIS DOCUMENT ELECTRONICALLY, I CONSENT TO VOLUNTARILY ENTER INTO THIS AGREEMENT FOR AUTHORIZATION OF D.R.I.V.E DEDUCTIONS WITH THE LOCAL UNION.

Agree

Signature *

Use your mouse, finger, or touch device to write your signature.