WTVP Membership / Pledge Form

Show your support of public media in Central Illinois

Join the WTVP Family today!

*indicates required information

 

Donor Information*
 

 

 
 

Title:

Mr.  Mrs.  Miss  Ms.  Other 
 

Name: 

* (first & Last)
 

Address:

*
 

City: 

*
 

State: 

* Zip: *
 

Phone: 

*
Please include area code
 

Email: 

*
 

 

Would you be interested in receiving email communication in the future?

 

 

Yes      No*

 Privacy

We respect your privacy and security. Therefore we do not share member's personal  information with others.

 

Additional Comments (optional)

Please add anything you would like us to know about your pledge or WTVP.


 

 Type of Contribution*

Sustainer (You may make an ongoing monthly gift until you tell us to stop.)

Annual Gift

 Your Membership Level*

$

All contributions $50 and above will receive an annual subscription to the WTVP Program Guide.

 

 Thank You Gift

Thank you Gift

 

No Gift, I would like all my pledge to support programming.

 Payment Schedule*

One Time Semi-annually Quarterly Monthly (Total broken into monthly payments)

 Credit Card Information
 
  VISA  MasterCard  Discover  American Express
 Card Number This is a secure website.
  Name as it appears on the card
Expiration Date

 

To charge by phone, use EFT, or make payment arrangements call 309-495-0555

or toll free 866-377-0555.

 

Employee Matching (optional)

Many employers will match the contributions made by you and/or members of your household - doubling the value of your gift. Just ask your Human Resources Department for a matching gift form and forward it to WTVP at any time. You may see a list of matching employers in the drop down menu below.

 

 

Employee Legal Name: 

    Active Employee Eligible Retiree Board of Directors

 
Caterpillar Foundation Educational and Cultural Matching Gift Program

The Caterpillar Matching Gift procedures have changed as of 7/1/2012. A link to the new Caterpillar Matching Gift Request form will be provided after your membership form has been submitted and will also be included in your thank you email.

 


 

 

 Submit

To send this membership form to WTVP on our secure server, click on the "Submit" button below. To clear the whole form and start over, click on the "Reset" button below.