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Payroll Deduction Authorization for SMUD Employees’ Association Membership Dues

The SMUD Employees’ Association (SEA) is a non-profit organization that promotes fraternity and fellowship among members by conducting educational, social and recreational activities. It also offers discounts and benefits to its members. Visit the SEA intranet page for more information.
Employee Number*
Name*
First Last
Mail Stop*
Address*
Street Address City State / Province / Region ZIP / Postal Code
I hereby authorize SMUD to withhold the sum of $5.00 from my earnings the first pay period each month for SEA membership dues. I further authorize SMUD to pay this amount to SEA. In the event of a deduction change approved by the SEA membership, SMUD is authorized to deduct the new amount from my pay.
I understand and acknowledge that the above deduction can be terminated at any time by my written notification to SMUD Payroll.
Date*
MM slash DD slash YYYY
Signature*
Phone
This field is for validation purposes and should be left unchanged.