Yes, I hereby authorize my Employer to deduct the sum of $1.00 per week from my paycheck and $5.00 annually the first pay period of July. Such amount to be transmitted to the UFCW International Active Ballot Club at such time and in such manner as may be agreed upon by my Employer and Local Union. I understand that this authorization is voluntarily made and that the amount suggested as a contribution is a guideline and that I may contribute more or less than this amount by any lawful means, other than this checkoff, or may refuse to contribute and that the making of payments to the UFCW Active Ballot Club is not a condition of membership in the Union or of employment with my employer and that I have a right to refuse to sign this authorization and not to contribute to the UFCW ABC without reprisal. I also understand that my contribution will be used for political purposes, including the support of candidates for federal, state and local office. I expressly reserve the right to revoke at any time this authorization in writing.