I am requesting Payroll Deduction as follows: Action ...

Payroll Deduction (please print clearly):Type of Deduction:(Select One per Form)– Location:_ Club MembershipRecreation Center Charge– UnrestrictedRedbucksFoundation – Specific Program:_ – _Total Amount of Deduction (per pay period): Deduction Frequency (check ONE): Monthly Bi-WeeklyFor Student Rec Center: ATTACH OPTIONS Form with Signature(The form must be completed with your … ................
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