Personal Information:
*First Name:
*Last Name:
Greeting:	Mr. Mrs. Ms. Dr.
Spouse:
*Address:
*City:
*State:	FL AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY *Zip:
*Primary Phone:	ex: xxx-xxx-xxxx
Secondary Phone:	ex: xxx-xxx-xxxx
*E-mail:
May we thank you on the air? Yes No

Pledge Information:
Membership Thank You Gift?   Yes No. Use all of my contribution for programming.
*Membership Type: New Member    Renewing Membership Additional Gift
*Pledge Levels and Premiums:
$52	WKGC Member ($1 per week)
$90.70	WKGC Frequency Club
$120	WKGC Bronze ($10 per month)
$180	WKGC Silver ($15 per month)
$240	WKGC Gold ($20 per month)
$365	WKGC Dollar-A-Day
Other	$
Optional Questions:
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