Please print this page and return with your contribution. THANK YOU!

Yes! I would like to support applying for a non-commercial radio station.

My Gift is enclosed.  __ $25    ___ $50    ___ $100   ___ $250    ___ Other

Please make checks out to:
“WVMA” and mail to PO Box 148  Enterprise, OR 97828

Name:______________________________     My Check for $________ is enclosed.

Address:____________________________    City ____________ST ____Zip______

Telephone_________________    email _____________________________________

Please charge $_____to my __ Visa __Master Card__ AME___ Discovery Card 

Please enter the following information exactly as it appears on your credit card statement. 

Account #__________________________________________  Exp. Date_________

Security Code (last three digits on the back of your card)    _____________

Signature_____________________________________________________________