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Stration: (optional) circle one Dem. Rep. None Other Contribution TO PAC: would like to make a contribution to CSEA Retirees political activity fund. I Enclosed is my check for a $10 a $25 a $50 a $100 a Other (Maximum $186.00/yr.) Payroll Deduction authorization: authorize a $2 I a $5 a $10 a Other (Maximum $15.50/month) to be withheld from my monthly pension for CSEA Retirees political action fund. I hereby.

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