| I want to give the
following amount to be deducted from my paycheck.
Contributions will be deducted together with my regular union
dues payment. |
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| Bronze | $1.00 | ||
| Silver | $2.00 | Contributions are not tax deductible. | |
| Gold | $3.00 | ||
| Platinum | $5.00 minimum or $_______ | For more information or an application, please contact the ROEA office at 248/358-4770. | |
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| Name ____________________________________ (please print clearly) | |||
| Signature ____________________________________________ | |||
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Please return this form to your building representative or directly to the ROEA Office |
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THANK YOU FOR SUPPORTING OUR CHILDREN! |
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