CWA DISTRICT 4 POLITICAL CONTRIBUTION REQUEST
Local No.______Date_________Date Check Needed_________
Address_____________________________________________
Amount Requested $________Date of Event_______________
Candidate/Issue Name & Address (legal name and address of committee that check will be made payable)
____________________________________________________________________________________________________
Office Sought__________________General______Primary______
Election Status (check one): Incumbent____Challenger__Open Seat____
Party (check one): Democrat____ Republican____ Independent____
Candidate Background: ________________________________________
____________________________________________________________
Candidate's voting record:______________________________________
____________________________________________________________
Has candidate supported CWA issues?________________ If so,
what?_______________________________________________________
What are the local plans to participate in the campaign/event?________
____________________________________________________________
____________________________________________________________
State Coordinator Comments/Recommendation:_____________________
____________________________________________________________
____________________________________________________________
Local President's Signature_________________________________
District 4 Approval_________________________________________
Return to your State Office
Rev 10/2007
kab/opeiulocal2-aflcio
