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:
What are your favorite WKGC Programs?
Comments: