Please
Print this by clicking the "Print" button on your browser task bar
and send to:
PAC Payroll Deduction Form
Special District NEA, 955 Gardenview Office Parkway,
St. Louis, MO 63141
Date __________________________
Local _________________________
Amount _______________________
I have read this form and understand that the Missouri National Education Association Political Action Committee (MNEA PAC) and the National Education Association Fund for Children and Public Education collect voluntary contributions from Association members to use for political purposes, including, but not limited to, making contributions to and expenditures on behalf of friends of education who are candidates for state and local (MNEA PAC) and federal (NEA Fund for Children and Public Education) offices. Contributions are voluntary and are divided between MNEA PAC (80 percent, with half of this used by local affiliates) and the NEA Fund for Children and Public Education (20 percent). Making a contribution is neither a condition of employment nor membership in the Association, and members have the right to refuse to contribute without suffering any reprisal. A member may contribute more or less than any requested or suggested amount, or may contribute nothing, without affecting his or her membership status, rights or benefits in NEA or any of its affiliates
Federal law requires political committees to report the name, mailing address, occupation and name of employer for each individual whose contributions aggregate in excess of $200 in a calendar year. Contributions or gifts to MNEA PAC or the NEA Fund for Children and Public Education are not deductible as charitable contributions for federal income tax purposes. If you wish to contribute to PAC through payroll deduction, please write the amount of your contribution in the space provided for PAC .
I hereby authorize
a PAC payroll withholding of $_____per pay period. This is in addition to my
regular membership deduction.
Name ________________________________
Address_______________________________
City __________________________________
School________________________________
Social Security #________________________
Special District NEA, 955 Gardenview Office Parkway, St.
Louis, MO 63141