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WUSB Donor Registration Form
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* Indicates required question
Email
*
Your email
First name
*
Your answer
Last name
*
Your answer
Street address
*
Your answer
City
*
Your answer
State
*
Your answer
Zip Code
*
Your answer
Phone Number (include area code)
*
Your answer
How would you like to make gift donation?
*
Recurring monthly credit card pledge of $5 or more per month.Use secure credit card link after submitting at end of form
One-time credit card pledge. Use secure credit card link after submitting at end of form
Email me an invoice
Post mail me an invoice
Would you like a thank you premium gift?
*
No thank you keep up the great radio!
Yes please! Choose below and write in the comments box below.
RECURRING AND 90.1 and 107.30 PACKAGE CHOICES If you selected "Yes, please!" above, please choose premium:
Monthly Recurring Pledge Package (premium offered corresponds with annual pledge total)
$90.10 Package (choose 3 items and check size below)
$107.30 Package (choose 4 items and check size below)
CHOOSE ITEMS --- THEN SIZES BELOW
Music CD Dj Choice
Mug
Baseball Cap
Tshirt
Sweatshirt
Other:
SINGLE ITEMS CHOICES If you selected "Yes, please!" above, please choose premium:
$75.00 (sweatshirt-- check off size below)
$50.00 (t-shirt-- check off size below)
$35.00 (baseball cap)
$35.00 (WUSB mug)
$15.00 (CD-- write-in favorite music genre in comments)
Special Premium offered (write in comments section below )
Other:
TSHIRT SIZE If you selected a premium that includes a sized clothing item, please check off size (write any special requests in comments box below.)
small tshirt
medium tshirt
large tshirt
xtra large tshirt
2X tshirt
Other request
SWEATSHIRT SIZE If you selected a premium that includes a sized clothing item, please check off size (write any special requests in comments box below.)
small sweatshirt
medium sweatshirt
large sweatshirt
xtra large sweatshirt
2X sweatshrt
Other request
For "Recurring Monthly Pledge" please confirm by writing in the MONTHLY dollar amount you wish to pledge.
Your answer
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.
Your answer
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. And Thank you from all of the WUSB Staff !
Your answer
A copy of your responses will be emailed to the address you provided.
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