Radio Broadcast Sponsorship Form
Please fill out this form and click submit. You can pay online ($105 to cover fee) or send a check for $100 with "Radio Broadcast" in the memo line.
Name
*
Email
*
This address will receive a confirmation email
Phone
*
Date I'd like to sponsor:
*
Please select all that apply.
Next available
No preference
Specific date (fill in below)
Preferred Date of Sponsorship (you'll be called if this date is not available, and asked to choose a different date).
I am donating
*
Please select all that apply.
in HONOR of someone/something
in MEMORY of someone/something
just to give.
Name(s) to be listed for honor or memory (or write NA).
*
Payment
Mail a Check for $100 ($0 )
Charge Card ($105 (to cover fee))
Mail a Check for $100 ($0 )
Charge Card ($105 (to cover fee))
Amount
Credit/Debit Card Number
Expiration Date/CVC
Name on Card
Card Billing Address
AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Submit
Description
Please fill out this form and click submit. You can pay online ($105 to cover fee) or send a check for $100 with "Radio Broadcast" in the memo line.
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