WUSB Donor Registration Form
Email address *
First name *
Last name *
Street address *
City *
State *
Zip Code *
Phone Number (include area code) *
How would you like to make gift donation? *
Would you like a thank you premium gift? *
If you selected "Yes, please!" above, please choose premium:
If you selected a premium that includes a sized clothing item, please write in size(S) required.
For "Recurring Monthly Pledge" please write in MONTHLY dollar amount you wish to pledge.
TOTAL dollar amount donated for pledge. *
If you are committing to a recurring monthly pledge, please multiple your monthly dollar amount by 12 (months) and indicate in the space provided below. If this is a one-time pledge please indicate that total in the space provided below.
Please share any further information you'd like us to know, any comments or questions, or indicate the show you are pledging for in the space below.
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