Dear Loyal Listener, Thank you kindly for your support of WVKR. Please print and complete this pledge form and return with a check or M.O. payable to WVKR, or your credit card information, to the address below. If your employer offers matching grants, please enclose a completed form with your payment. We accept Visa, MasterCard, and American Express. Best regards, Jay Lancaster, General Manager (845-437-5475) WVKR Pledge Drive 2014 Box 726 Vassar College 124 Raymond Ave. Poughkeepsie, NY 12604-0726

NAME______________________________________________________________ ADDRESS____________________________________________________________ CITY, STATE, ZIP______________________________________________________ PHONE NUMBER_____________________________________________________ EMAIL (OPTIONAL)____________________________________________________ FAVORITE SHOW/s______________________________________________________________ AMOUNT ENCLOSED $_______________________ MATCHING FORM ENCLOSED? ________Yes ________No Check one: _______ I want WVKR to get all of my donation and I decline premiums _______ $0.01- $24.99: Sticker _______ $25.00 - $49.99: Sticker, Two Can Koozies (in blue and black) _______ $50.00 - $74.99: Sticker, Two Can Koozies, 2014 Tee _______ $50.00 - $74.99: Sticker, Two Can Koozies, Vintage Tote _______ $50.00 - $74.99: Geetmala Show CD _______ $50.00 - $74.99: Polka Beat Show CD _______ $75.00 - $99.99: Sticker, Two Can Koozies, 2014 Tee, Potholder _______ $100.00 - $149.99: Sticker, Two Can Koozies, 2014 Tee, Potholder, Vintage Tote _______ $150.00+: Sticker, Two Can Koozies, 2014 Tee, Potholder, Vintage Tote, Vintage Tee, Misc. Goodies ______Visa

______Mastercard

____American Express

Name on Card: ___________________________________________________ Card Number: _____________________________________________ Expiration date: __________ CVV (verification number on card):_________ 2014 T-SHIRT: circle size and color First Choice Size

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Lime

XXL Yellow

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Lime

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Yellow

VINTAGE TEE: size choice only Size

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2014 online pledge drive form final.pdf

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