"*" indicates required fields

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Please enter a number from 01 to 99.
If you are filling out this form while on the phone with a caller, you will choose 'Telephone'. If you are performing data entry, you may need to select one of the other options.
Is this an Early-Bird pledge?*
(For data entry purposes only - any pledges received/postmarked October 19th or earlier are considered Early-Bird pledges. For all other pledges, please select 'No')
Would you like to make your pledge monthly, or as a lump sum?*
Monthly pledges can only be made by credit card, and are available for pledges of $60, $125, $250 or $500 only.
Please enter a numeric value only, with no dollar sign (i.e. 93.70).
Is this pledge eligible for incentives?*
Any pledge above $60 is eligible for incentives
Incentives*
Please put a checkmark beside all incentives the Pledger is eligible for, and wishes to receive. If they do not wish to receive any incentives, place a checkmark beside 'NO INCENTIVES'
Please enter the name of the donor's chosen charity
Are you a CJNU member?*
Please capitalize the first letter
Please capitalize the first letter
Address*
Please enter the full street address, with each word capitalized. For Provinces and US States, please enter the two letter code (i.e. MB for Manitoba)
Please enter the full 10-digit phone number - numbers only. If the pledger does not wish to give their phone number, please enter N/A. We must have either a phone number or email so we can get in touch if the pledger is a prize draw winner, etc. If the pledger does not provide either of these, they will be ineligible for prize draws.
If the pledger does not wish to give their email, please enter [email protected]. We must have either a phone number or email so we can get in touch if the pledger is a prize draw winner, etc. If the pledger does not provide either of these, they will be ineligible for prize draws
Can we mention your first name on-air?*
This is for the purpose of recognizing and thanking pledgers, or announcing prize draw winners. If you are performing data entry and do not have this information, please select 'No'.
Is it OK if we stay in touch with you?*
CJNU produces a monthly newsletter which we would send you by email. We may also get in touch to make you aware of important happenings at the station. We will only do so if we have your permission - as per Canadian Anti-Spam Legislation. If you If you are performing data entry and do not have this information, please select 'Don't Know'.
Along with your generous Pledge, for an additional $25 would you like to become a CJNU member today?*
Membership has its perks!
Please enter the name as it appears on the card; the full card number with no spaces (for Visa and Mastercard this will be 16 digits starting with a 4 or 5, for AMEX this will be 15 digits starting with a 3); the expiry date in the format MM/YY, the security code (three digits on the back of the card - or for AMEX, four digits on the front of the card); and the Postal or ZIP code associated with the card (this could be different to the postal code provided earlier!)

Cheque

Cheques should be made payable to CJNU, and mailed to: L7 - 1 Lombard Pl, Winnipeg, MB, R3B 0X3

eTransfer

eTransfers should be sent to [email protected]. CJNU is set up for auto-deposit, but if your financial institution requires you to add a secret question, please ensure the answer is "Winnipeg"

Cash

Cash payments received in person should be placed in an envelope. Please write PLEDGE DRIVE, along with the donation amount, and the full name of the donor, and leave the envelope in the designated place on Adam's desk.

CANNOT PROCESS CARD

If you have made multiple attempts, but are unable to process someone's credit card, please immediately inform Adam or Dan, so that we can follow up with them later.

Whoops!

Monthly pledges can only be made by Credit Card. Please ensure you have selected 'Credit Card' as the method of payment!

Whoops!

Monthly pledges can only be made by Credit Card. Please ensure you have selected 'Credit Card' as the method of payment!

Whoops!

Monthly pledges can only be made by Credit Card. Please ensure you have selected 'Credit Card' as the method of payment!

Whoops!

Monthly pledges can only be made by Credit Card. Please ensure you have selected 'Credit Card' as the method of payment!

Whoops!

Monthly pledges can only be made by Credit Card. Please ensure you have selected 'Credit Card' as the method of payment!

Whoops!

Monthly pledges can only be made by Credit Card. Please ensure you have selected 'Credit Card' as the method of payment!

Whoops!

Monthly pledges can only be made by Credit Card. Please ensure you have selected 'Credit Card' as the method of payment!