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KPVU 91.3 FM

Pledge Form

1.
General Information
Date
Time
Specific Programming
Volunteer Name
2.
Are you a
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?
Mouse Pad
Water Bottle
KPVU Tote
Yellow T-Shirt
KPVU Umbrella
5.
T-Shirt Size
6.
BUSINESS/ORGANIZATION/CHURCH UNDERWRITING PACKAGE LEVELS
Special Premium Item
Total Amount Pledged
7.
Donation Amount other than membership level
Dollar Amount
8.
May we announce your name on the air?
9.
What is your music preference?
10.
What is your birth month and day
Month
Day
11.
Total Pledge
$
12.

For Prairie View A&M University Employees:

Would you like to have your membership taken out by Payroll Deduction?
Total Monthly Contribution
Total Amount
Work Phone Number
Where should we send the Payroll Deduction form