"Bill Me"
Please fill these items in so that we can contact you:
Full Name:
Street Address:
City:
State:
Zip code:
Phone # :
Email address
Please indicate the amount you would like to pledge:
$35 - New Member
$60 - Affiliate Member
$90 - Challenge Member
$120 - Charter Member
$365 - Firehouse Fellow
$500 - Benefactor
$1000 - Radio Ridge Society
Other Amount:
How often would you like to be billed?
Single Payment
Semi-annual Billing (for pledges of $60 or more please)
Quarterly Billing (for pledges of $120 or more please)
Monthly Billing (for pledges of $120 or more please)
May we thank you by name over the air?
No, I'd rather remain anonymous.
Yes.
Yes, but use the following name on air.
Name to use on air:
Would you like to receive e-mail announcements about WFHB special events and station news?
Yes
No
Any comments or ideas?
