NON ALLOCATION TO PAC

To: CVEA Treasurer

FROM: _________________________________

DATE:___________________________________

I choose not to allocate $1.00 a month of my Cajon Valley Association Dues to the Cajon Valley Education Political Action Committee, and want all my dues to remain in the Association's general fund.

Last 4 SS#_________________ Date_______________

Signature_____________________________________

School site____________________________________

(Return to CVEA through district mail)