WUSB Donor Registration Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Email *

First name *

Last name *

Street address *

City *

State *

Zip Code *

Phone Number (include area code) *

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.

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. And Thank you from all of the WUSB Staff !

A copy of your responses will be emailed to the address you provided.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms