Contemporary Letter

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             .                                                                       LCMMA
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             .                                                                       1331 S. Ham
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             .                                                                       Lodi, CA 95242
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           Lodi City Mid-Managers Association
   Date: _____/_____/_____
   I hereby request and authorize the City of Lodi to deduct from my earnings each pay
   period, 24 pay periods annually, the amount of ten dollars ($10.00) to pay the current rate
   of membership dues of the Lodi City Mid-Management Association (LCMMA).
   I understand that this authorization may be used by the said employee organization as its
   authorization to represent me in matters concerning the terms and conditions of my
   employment with the City.
   I understand that membership dues, agency service fees, contributions or gifts to
   LCMMA are not tax deductible as charitable contributions for Federal Income Tax
   purposes. However, they may be tax deductible as ordinary and necessary business
   expenses
   Date:                                               Employee Number:



   Employee Signature:



   Employee Name (please print):



   Job Classification:




   Home Address:



   City:                             State:                              Zip Code:



   Home Telephone:                                     Work Telephone:



           Forward to the Finance Department/Payroll


                                              ............................
LCMMA