You have chosen:

Pledge Amount:

This pledge is a(n):
 New Membership
 Membership Renewal
 Additional Gift

Payment Method: Credit Card Check PSU Payroll Deduction Monthly Electronic Funds Transfer (EFT)

NOTE: You will enter payment information on the next screen. Payments are handled through PSUPay. WPSU cannot charge credit cards for monthly payments.

Name and/or Business:

Address:

City:

State: STATE AL AZ AR CA CO CT DE DC FL GA ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA SC SD TN TX UT VT VA WA WV WI WY  Zip Code:

Telephone: Area Code: - Prefix: - Suffix:

E-mail Address:

May we use your name on the air?
Yes / No

Would you like to add $3.00 to your pledge amount to cover shipping costs?
Yes / No

Please add any additional comments you might have for our staff.