VOLUNTARY CAP PAYROLL DEDUCTION AUTHORIZATION I hereby authorize the State System of Higher Education to deduct from earnings each paycheck, the amount certified below as a voluntary contribution to APSCUF's political action committee (APSCUF/CAP). My contribution is voluntary and I understand that is not required as a condition of membership in any organization. I understand that contributions to APSCUF/CAP are not deductible as charitable contributions for federal income tax purposes. This authorization shall be valid while I remain in the employ of the State System of Higher Education unless I notify APSCUF and the State System in writing that this authorization is revoked.Date MM slash DD slash YYYY Name First Last Employee ID NumberUniversityPlease Choose:BloomsburgCaliforniaCheyneyClarionEast StroudsburgEdinboroIndianaKutztownLock HavenMansfieldMillersvilleShippensburgSlippery RockWest ChesterI would like to receive email updates about CAP at this email address I am interested in the following CAP activities Fundraising Events Golf Outings Legislative Meet-and-Greets Payroll DeductionPer pay period +$5.00 +$10.00 +$20.00 +$25.00 Other (Please specify amount) Please Enter a Specific Amount for Payroll DeductionSignatureNameThis field is for validation purposes and should be left unchanged. Δ
