Secure Online Membership Form
Indiana Public Radio

Contact Information:
Title:
Dr.     Miss     Mr.     Mrs.     Ms.  
* Last Name:
* First Name:
* Address:
* City:
* State:
* Zip:
* Day Phone:
 Evening Phone:
* E-Mail Address:
 
  $40   $75   $100   $150   $175   $250   $500 
   Other:$
 
*

Please mark my pledge as

 a renewal
 a new membership  
 an additional gift
 
With your pledge you may choose among these fine IPR Extras:
  No gift
 
 
 

$75 Pledge

 Choose ONE :
 Wait, Wait…Don’t Tell Me! Dignity T-shirt   
 IPR Baseball Cap (one size fits most)
 
     
  $100 Pledge
 Choose ONE :
 Listening is an Act of Love CD
 Symphonic Brass CD
 A Prairie Home Companion Duets CD
 
 
  $150 Pledge
 NPR’s Funniest Driveway Moments, 2 CD Set
 
 
  $175 Pledge
 Restaurant Certificate & Sponsor Day
  (*Restaurant certificates are first come, first served.)
Restaurant 1st choice
Restaurant 2nd choice
  Sponsor Day only
 
 
 

$250 Pledge

 Choose ONE :
 IPR Highway Car Kit
 IPR Organic Market Bag Set
 
 
$500 or more - Members Choice!
Choose 4 items from the 5 previous levels as listed below:
(one IPR Extra per pledge level please)

 

 
 From the $75 IPR Extras:
 Choose ONE :
   Wait, Wait…Don’t Tell Me! Dignity T-shirt   
    IPR Baseball Cap (one size fits most)

 From the $100 IPR Extras:
 Choose ONE :
   Listening is an Act of Love CD
   Symphonic Brass CD
   A Prairie Home Companion Duets CD

  From the $150 IPR Extras:
 NPR’s Funniest Driveway Moments, 2 CD Set

 From the $175 IPR Extras:
Restaurant Certificate & Sponsor Day
(*Restaurant certificates are first come, first served.)
 
Restaurant 1st choice
Restaurant 2nd choice
Sponsor Day only
 
 
 

 From the $250 IPR Extras
 Choose ONE :
   IPR Highway Car Kit
   IPR Organic Market Bag Set



 
 

* Payment Option:
Lump Sum Billing
Monthly
Quarterly
Semi-Annually
* Payment Method:

Invoice me for my pledge amount.

BSU Payroll Deduction

American Express
Discover
MasterCard
VISA
Credit Card Number:
Expiration Date(MM/YY) /

Matching Pledge:
(if applicable)
Employer Matching

If your employer will match your gift, ask your personnel office for a matching gift form and fax it to us at (765) 285-8937.

Company Name:

 
 
 
Would you like to receive our monthly program guide, WAVES? by email
 by US mail
No, thank you
 
 
What are your favorite programs?

(Check all that apply.) 		Morning Edition
Classical Music
All Things Considered
Performance Today
Car Talk
A Prairie Home Companion
Other
 
 
Would you like to make your contribution to IPR continuous (become a Sustaining Member)? Yes    No
 
 
May we use your name on the air? Yes    No   
 
 
Which station(s) do you listen to?
 WBST 92.1 FM, Muncie
WBSB 89.5 FM, Anderson
WBSW 90.9 FM, Marion
WBSJ 91.7 FM, Portland
WBSH 91.1 FM, Hagerstown/New Castle
 
 
May we list your name in our program guide? Yes     No    
 
 
Questions or Comments: