PAC Deduction Form

Print out this page, complete, SIGN, and date it, and send it to the Union Office (MS 1102F). E-mails are not acceptable as we need your signature; however, faxes are okay. Thank you!

I hereby authorize my employer, Baltimore County, to deduct the amount indicated below from my salary, and to pay this money in addition to my regular union dues to the Baltimore County Professional Fire Fighters Association, IAFF Local 1311. *Please initial by your choice:

__________ Local Founders Circle: $12.00 per month ($144 / year)

__________ President's Club: $9.00 per month ($108 / year)

__________ Capitol Club: $6.00 per month ($72 / year)

__________ Basic PAC Member $3.00 per month ($36 / year)

The Baltimore County Professional Fire Fighters Association will deposit my contribution, on my behalf, into the account of the Baltimore County Fire Fighters Political Action Committee, and will utilize my contribution exclusively for political activities intended to promote the interests of Baltimore County Professional Fire Fighters Association and its members.

_____________________________________________________
EMPLOYEE NAME

_____________________________________________________
EMPLOYEE SIGNATURE

_____________________________________________________
EMPLOYEE SOCIAL SECURITY #

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DATE

E-mail the Local
Michael K. Day Sr., President BCPFFA
52 Scott Adam Road, Cockeysville, MD 21030-3282
410-683-1311 ~ 410-666-0156 (fax)

BALTIMORE COUNTY PROFESSIONAL FIRE FIGHTERS ASSOCIATION

PAC SUPPORT

BALTIMORE COUNTY
PROFESSIONAL FIRE FIGHTERS ASSOCIATION