Join ACOA – Alabama Corrections Officers Association

Today's Date *

Employee Name *

First

Last

Employee Number *

Social Security Number

Employee Email Address *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Type of Deduction

Legislative Lobbying by ADOC Officers, Retirees, Medical and Admin Staff

Rate Per Month

$7.00

Authorization

I hereby authorize Alabama Comptroller Department to make the above deduction from my wages per month. I understand that this rate will be withdrawn and deposited with ACOA for services that represent ADOC employees. I further understand that this rate will be deducted from my earnings after all federal, state and local requirements and any additional deductions and deposits I have authorized..

I understand that the undersigned is responsibile to stop any other deductions for lobbying representation from payroll or drafts on personal financial institutions.

ACOA represents ADOC OFFICERS, medical and administrative staff, retirees ONLY. ACOA does not represent any other employees or any other entities.

Date Signed *

Employee Signature *