Application for Retiree Unit/Council Membership

Street Address
Were you a member of CSEA when you retired?
Select one:

 


 

Support CSEA's Political Education Fund

 

Monthly Payroll Deduction (For CalPERS Retirees)
I hereby authorize CalPERS to deduct each month the sum of:

I understand that my contributions will be used to advance the political interests of classified employees, public education, working families and the labor movement by supporting federal, state and local candidates, and that any contributions over $200 per calendar year will be used to support or oppose ballot measures and pass school bonds and parcel taxes. I understand that this authorization is voluntary and that I may refuse to contribute without reprisal. (The amounts shown are only suggestions. You are free to indicate any amount you choose and there will be no favor or disadvantage by reason of the amount of your contribution or your decision not to contribute. This authorization may be revoked in writing at any time.)

Contributions to the CSEA Political Education Fund are not deductible for federal income tax purposes. The effective date will be the date of the next warrant following receipt of this application by CalPERS.

 


 

Dorothy Bjork Assistance Fund CalPERS Deduction

I understand that my DOROTHY BJORK ASSISTANCE FUND contribution is in addition to my retiree unit dues deduction. The effective date will be the date of my next retirement check following receipt of this application by CSEA. This authorization shall remain in full force and effective until revoked in writing by me.