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Monthly Fund Drive Donation Form
Monthly Donation Amount & Premium. Includes Shipping!
*
$100
-
Shirt + Mug/Coffee + PIF
$61
-
Shirt + Mug/Coffee + PIF
$51
-
Shirt + Mug/Coffee
$41
-
Shirt + Mug/Coffee
$31
-
Shirt + Mug/Coffee
$21
-
Shirt + Mug/Coffee
$11
-
Shirt
$
Your gift will be made
Monthly
Premiums
*
Yes! I want my Donation Level Premium (Shirt, mousepad, etc)
Not needed, I'll skip receiving a premium for my support
Shirt Size
*
Small
Medium
Large
X-Large
XX-Large
XXX-Large
XXX-Large Tall
Contact Information
Name
First Name
Last Name
-- and/or -- Organization Name
Address
*
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
Email
*
Verify Email
*
Are you an active WRIR Volunteer?
Yes
Employer
Questions?
Email:
fundraising@wrir.org
Add 3% to my total amount to help cover the payment processing fees