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DONATE A PREMIUM
Please fill out this form if you have a premium you would like
to donate on-line for Public Radio Week, February 21-March 1, 2009.
Last day to donate is Friday, February 27th at Noon.
For questions call 406-243-4044 or 1-800-325-1565.


Start Here:
Your donation is a :
My premium is a service: GO DIRECTLY TO #2 "PREMIUM INFO"
My premium is an item: GO TO #1 "SHIPPING INFORMATION"
 
1. Shipping Information (choose one):
I will bring the item to Montana Public Radio.
      STOP: DO NOT FILL OUT THIS FORM.
      WE WILL GET YOUR INFORMATION WHEN YOU DROP OFF YOUR ITEM.
      Bring to the Montana Public Radio business office, Performing Arts
      Radio/TV Bldg, room 170, on the UM-Missoula campus
      PLEASE...NOTHING BIG, HEAVY OR FRAGILE.
I will mail the item to the person who pledges for it.
The person who pledged for the item can pick it up from me

I will deliver the item to the person who pledges for it within the following area(s) :
I will mail the item to MTPR.
        Click this link, print the form and mail it with your donation.
 
2. Premium Info:
Previous Premium Donor:
 
Description of Premium 1:
How many are you donating?
Retail value of each item:
Expiration Date:
Special Instructions:


Description of Premium 2:
How many are you donating?
Retail value of each item:
Expiration Date:
Special Instructions:


Description of Premium 3:
How many are you donating?
Retail value of each item:
Expiration Date:
Special Instructions:
3. Personal Information:
First Name:
Last Name:
Address:
City:
State:
Zip:
Daytime Phone:
Evening Phone:
Email Address: * required
Business Information (if donation is from a business):
Business Name:
Address:
City:
Zip:
Phone:
Email Address:
Contact Person when collecting the premium:
 
 
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