Pledge a Donation of Support

If you prefer to call in your pledge of support you can do so by dialing 866-5454 or toll free 1-888-541-9601.

Phone Number --

Prefix ---Mr.Mrs.Ms.Dr.Prof.Rev.

First

M.I.

Last

Suffix ---Jr.Sr.IIIIII

Address

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City

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Country United StatesCanada

Email Address *

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I would like to donate to:  WQLN TV  WQLN Radio  WQLN Kids Club  WQLN in general

Would you like to receive a thank you gift?  Yes  No

Donation $

Membership in the WQLN Kids Club is $60 for the first child and $5 for each additional child. First Name Last Name Bithdate (mm/dd/yyyy) // Shirt Size SmallMediumLarge Gender Boy Girl $60 [+] Add another child (+$5)    [-] Remove a child (-$5) WQLN Kids Club Membership $   Additional Children $   [What is this?]  Additional Pledge Amount $ * Total Donation $

For which program would you like a thank you gift? Program Select Program Pledged - For Employee Use Please select your pledge level [Tell me more about] $150 - Tickets FRONT ROW: Celtic Thunder-Take Me Home Erie, PA Concert $125 - Combo: CD, DVD Celtic Thunder Take Me Home $95 - Tickets: Celtic Thunder-Take Me Home Erie, PA Concert $90 - DVD: Celtic Thunder Take Me Home $75 - WQLN Membercard $60 - CD: Celtic Thunder-Take Me Home $40 - WQLN's Basic Membership Level   [What is this?]  Include shipping & handling cost? Yes No $   [What is this?]  Additional Pledge Amount $ * Total Donation $

How would you like to pay?   Visa   Mastercard   American Express   Discover   Bill Me

Name on card	Card Number	Expires (mm/yy) /	CID [What is this?]
Free Magazine Subscription: None Newsweek

Many companies match their employee's donations to non-profit organizations.

May we have the name of your and/or your spouse's employer? *

For programming research purposes, may we have the year you were born? *

We value your questions, comments, and concerns. Please let us know what's on your mind. *