Personal Information:

Prefix: Select... Mr. Mrs. Miss Mr. and Mrs. Pastor Dr. Ms. Mstr. Sr. and Mrs. Pastor and Mrs.   Last Name:   First Name:

Home Phone:    Work Phone:    Email Address:

Address:   City:   State:   Zip:

___________________________________________________________________________________________

Faith Promise Information (fill out only form parts that apply to you):

Day Sponsor: no yes (if yes, please fill out form below)

                Day Sponsor Contact:

                Select Full or Half Day Sponsor: select... full ($900) half($480)

                Enter requested date for airing of Day Sponsor:     

                Morning/Afternoon? (half day only) select... am pm

Monthly: no yes (if yes, please fill out form below)

               Is this a renewal or a new faith promise? renew new

               Faith Promise Amount:  $

        Did you know that you can have your gift automatically deducted each month without having to deal with a  check?        To sign up today for WBFJ's ATF program simply download the form (ATF.doc), fill it out and mail it in.   

One-Time Gift:  no yes   (if yes, please fill out form below)           

             One-Time Gift amount:   select... $1 a day ($365) $1000 $2500 other

             If you selected "other" enter the amount: $

Sponsor a month on wbfj.fm ($750): no yes      

              Which month? select... January February March April May June July August September October November December

ATTENTION: Please make sure all information is correct before submitting.  We want to make sure our totals reflect the correct information.  Your time and gift are greatly appreciated.