
Providing hope to AFA members
Automatic Payroll Deduction Form
I hereby authorize and direct my Company to deduct the following amount from the gross earnings of each of my paychecks and remit to The Pegasus Project. This assignment, authorization and direction shall remain in effect until revoked by me in writing to The Pegasus Project.
ڤ $2.00 ڤ $5.00 ڤ Other Amount $________
ڤ $3.00 ڤ $10.00 ڤ Changing Previous Deduction to $________
_________________________________ __________________________________
Print Last Name Print First Name
____________________________________ _____________________________________
Airline Domicile
____________________________________ (_________)___________________________
Employee Number Phone Number
____________________________________ ____________________ ______ _________
Address City State Zip Code
____________________________________ ______________________________________
Signature Date
Please send this form to the following address or submit to your Local Union Office
The Pegasus Project
PO Box 40035
Phoenix, AZ 85067-0035
The Pegasus Project is a Non-Profit Organization, which provides financial grants to members of AFA who are facing life-threatening illness or injury. No portion, of a member’s dues, are used to support Pegasus. The success of the Pegasus Project is dependant on the generosity of AFA members making donations through automatic payroll deductions and through Council Fundraising Events. Donations to Pegasus are tax-deductible. Thank you for supporting The Pegasus Project!