WORT MAIL-IN PLEDGE FORM

Please note: WORT's mailing list is confidential and is never sold or loaned to anyone.

Please print this form, fill it out and mail it with a check to: 118 S. Bedford St., Madison, WI 53703 You may also stop by the station and drop it off.

First_Name(s):__________________________________________________________
Last_Name:______________________________________________________________
Address:________________________________________________________________
City:___________________________________________________________________
State:__________________________________________________________________
Zip:____________________________________________________________________
Phone:__________________________________________________________________
email:__________________________________________________________________

Is this the first time you have ever pledged to WORT?
__ YES __ NO

(If no,) Has your address changed since you last donated?
__ YES __ NO

How much would you like to pledge today?
__ $200 __ $100 __ $80 __ $60 __ $40 __ Other: $________

WORT Premiums

Premium Gift: __ Hat (min. $80) __ Shirt (min. $50) __ Coffee mug (min. $40)

Shirt Size: __ XXL __ XL __ L __ M

  • Please include $3.00 shipping and handling to have your premium mailed to you, or if you wish, you may pick up your premium at the station during business hours.

    What are your three favorite WORT shows?

    1.__________________________________________________________

    2.__________________________________________________________

    3.__________________________________________________________

    Thank You for supporting W.O.R.T.!!