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As a member of CSATF, I receive a Benefit in an issuance of a $10,000 Life Insurance Policy. I hereby certify that I am a member of California Staff Assault Task Force (CSATF). If not a member, I am making application for membership in CSATF and authorize the California State Controller to deduct from my salaries and wages the amount specified now or in the future for membership dues. This authorization will remain in effect until canceled by me or the organization at my written request. I certify that I am a member of the above named organization and understand that termination of membership will cancel all deductions and benefits under this authorization. I authorize CSATF to collect the monthly minimum ($15.00) dues amount for my membership. Upon California D.O.C. retirement, I agree to become a ($10.00) per month CSATF Associate Member.

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