Page 1

    2012 LSCU PAC YOUR JEANS/PAYROLL DEDUCTION LSCU/LSCU Service Corporation Employees NAME:_________________________ (Please Print Name) I hereby authorize the League of Southeastern Credit Unions to make the following deductions from my paycheck for the LSCU FEDPAC. I agree to continue contributing at this level each year until I rescind or change the amount in writing. CHECK ONE: ____

Chairman’s Club Membership ($500.00 or more) Deduct at least $19.24 per pay period. $ _____ Amount to be deducted if greater than minimum required.


President’s Club Membership ($250.00) Deduct $9.62 per pay period. (Jeans Each Friday for Management Team and Above)


Congressional Club Membership ($100.00). Deduct $3.85 per pay period. (Jeans Each Friday for Employees not on the Management Team)


Capitol Club Membership ($50.00). Deduct for $1.93 per pay period.


Ambassadors Club Membership ($25.00). Deduct $5.00 for 5 pay periods.


Enclosed is my check for____________.

Deductions will start with the January 13, 2012 payroll. All forms are due to Human Resources by December 30, 2011. Signature:_________________________________Date:_____________________

Note: Individual contributions are directed to the LSCU FEDPAC. These funds are used to support bi-partisan Alabama and Florida federal candidates. Contributions are not tax deductible. Contributions are voluntary and individuals have the right to refuse to contribute without any reprisal.

Thank you for supporting credit unions!