*First Name:
*Last Name:
Additional Name:
Pronunciation:
*Address:
*City:
*State:
*Zip:
*Phone:	Example: xxx-xxx-xxxx
Email:

*Required Field
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Are you a new or renewing member?:
a New Member a Renewing Member Making An Additional Pledge

At what level would you like to pledge?:

Please select a pledge level $2500 Tesla Gold: 6 Day Sponsorships + Signed Artist Print + Tumbler + Snack Bag + Mug + Shirt $1500 Tesla Silver: 4 Day Sponsorships + Signed Artist Print + Tumbler + Snack Bag + Mug + Shirt $1000 Tesla Bronze: 2 Day Sponsorships + Signed Artist Print + Tumbler + Snack Bag + Mug + Shirt $400 Leadership Circle: Full Day Sponsorship + Tumbler + Snack Bag + Mug + Shirt $250 Premium Level: Tumbler + Snack Bag + Mug + Shirt $225 Personal Half Day Sponsorship $200 Mug + Shirt $175 Mug + Snack Bag $150 Shirt $125 Mug $89 Tumbler $60 Snack Bag Other Amount

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May we thank you on-air?
Yes No

Are you interested in premiums?
Yes No

Will you pick up your premiums?
Yes No, please mail.

What size T-shirt would you like?
No Shirt Small Medium Large XL 2X

Will your employer match your pledge?
No Yes

What is your employer's name?

Some employers will only match your contribution,
minus the value of any premiums you select.

Pledge it Forward! Please enter the name of the non-profit you would like to celebrate.

KMUW reserves the right to refuse a requested 501(c)(3) announcement should it be deemed inappropriate for public broadcast.

Do you have any comments?
Please submit your Day Sponsorship information here, or call Pat Hayes at 978-7171 to schedule a Day Sponsorship.

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How would you like to pay?
Pay NOW with E-Check or Credit Card Please send me a bill. I will stop by the station and pay. I would like to setup a WSU Payroll Deduction plan. Have Envelope, Will Mail

For the WSU Payroll Deduction plan you may download the necessary form here, or:
I will stop by the station and fill out my form. I will print off and mail my form. Please mail me a form.

KMUW has not and will not rent or exchange personally identifiable donor information to any third party.

KMUW is prohibited by Section 396(k)(12) of the Corporation for Public Broadcasting Community Service Grant from renting contributor or donor names, or other personally identifiable information, to or from, or exchanging such names or information with any candidate, political party or political committee. KMUW is also prohibited from disclosing this personally identifiable information with any nonaffiliated third party.

KMUW does identify donors by name and leadership level in the Annual Report and newsletter. Any donor that does not wish their name to be included in these publications, should notify the KMUW Membership Coordinator at 316-978-6789 or info@kmuw.org