Sustainer's Membership Form

Alabama Public Radio Sustainer's Membership Enrollment Form

Name:
Address:

City:
State:
Zip:
Telephone:
E-Mail:

Method of Contribution (Please choose one:)

Visa MasterCard Discover American Express

Card Number:

Exp. Date: Security Code:

Amount you wish to donate per month:

Optional: Initial here _________ for Inflation Guard. This will automatically increase your gift by 10% annually.

I understand that this agreement will remain in effect until I notify Alabama Public Radio to stop. I also verify that I am the owner of the account listed above.

_________________________________

Signature

_____________

Date

Print then Mail Enrollment Forms To:

Alabama Public Radio
Membership Department
Box 870370
Tuscaloosa, AL 35487