Your Name:
Title Mr. Ms. Miss Mrs. Dr.	First Name*	Initial	Last Name*
Your Spouse or Partner's Name:
Title Mr. Ms. Miss Mrs. Dr.	First Name	Initial	Last Name
If giving as an organization Please provide your organization's name:

Your Mailing Address:
Street Address*
City	State	Zip Code	Country
May we please have phone number or e-mail address in which to contact you should you win any of the drawings or in the event of a question regarding your pledge?
E-mail*		May we contact you by e-mail for programming or membership information? Yes No
Home Phone Example: 513 555 1234		Work Phone Example: 513 555 1234
Contributors outside the U.S. may also wish to enter their complete address and telephone information in the "comments" section at the bottom of the next page.
Your Old Address:
If you've contributed to WGUC before and have moved, please provide us with your old address: Street Address
City	State	Zip Code	Country

Your Membership History:

Membership Type* I'm a new member. I'm renewing my current membership. I'm rejoining after a lapse in membership. I'm giving an additional gift (in addition to my current membership).

Your Gift To WGUC:
Would you like to set up a Sustaining Membership?    A sustaining membership is automatically renewed at the end of one year and will remain in effect until you contact WGUC to cancel or change the amount of your monthly or annual gift.
What is the total amount of your gift?* Select an amount from the drop down menu or enter an amount in the Other field. $48 $60 $75 $90 $120 $365 $500 $1000 Other $ If you choose to play by installments, please enter your total annual contribution. Example: $10/month = $120.	How would you like to be billed?* Due to credit card processing fees, contributions of less than $72 must be billed as a lump sum. Consecutive month billings will take place during the first week of each month. One Lump Sum (Saves processing fees) 12 Consecutive Months
How would you like to pay for your pledge?* To pay by check, please call us at (513) 419-7155. (Please note: PayPal can be used for lump sum payments only) Visa Master Card Discover American Express PayPal