KPVU 91.3 FM
Pledge Form
1.
General Information
Date
Time
Specific Programming
Volunteer Name
2.
Are you a
Renewing Member
New Member
3.
Member Information
Name
Address
Suite/Apt#
City
Postal Code
Home Phone
Business Phone
Email
4.
INDIVIDUAL MEMBERSHIP LEVELS
What level would you like to pledge today?
$15 Student Level (Lanyard)
$35 Level (Lunch Bag)
$65 Level (Hat)
$91.30 Level (T-Shirt)
$150 Level (Umbrella & Coffee Mug)
$250 Level (Sponsor/Underwriter) Ten 30 sec. On-Air Spots
Special Premium
5.
Donation Amount other than membership level
Dollar Amount
6.
May we announce your name on the air?
Yes
No
7.
What is your music preference?
Blues
R&B
Gospel
Other
Jazz
8.
What is your birth month and day
Month
Day
9.
Total Pledge
$
10.
For Prairie View A&M University Employees:
Would you like to have your membership taken out by Payroll Deduction?
Total Monthly Contribution
X 9 Months
X 12 Months
Total Amount
Work Phone Number
Where should we send the Payroll Deduction form
11.
BUSINESS/ORGANIZATION/CHURCH UNDERWRITING PACKAGE LEVELS
$300 Bronze Sponsor
$500 Silver Sponsor
$1000 Gold Sponsor
$3000 Royal Purple & Gold Sponsor
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