WQPT Membership

Member Selection

Thank you for choosing to become a WQPT Sustaining Partner. Your
continuing contributions help support programming that educates, enlightens and entertains. Please select one of the easy installment options below.

If you have questions about becoming a Sustaining Partner, please call WQPT at 309/796-2424 or 1-800/747-2430 and ask for Membership. You may also
e-mail us at wqpt@bhc.edu to request a thank you gift list.

Sustaining Member Payment Options
Monthly Installments Quarterly Installments
  $5.00 (minimum)   $15.00 (minimum)
  $10.00   $30.00
  $15.00   $45.00
  Other amount    Other amount 

Member Information

Name
Street Address
City
State
Zip Code
Daytime Telephone Number - -
Email Address (optional)
Payment Information
Credit Card
  Card Type
  Credit Card #
  Credit Card CVV
(What is this?)
  Exp Month    Exp Year 
Name on Credit Card
if different from above
Billing Address
if different from above
City
State
Zip Code
Electronic Funds Transfer (EFT) Regular transfers from my checking or savings account.  Available for annual membership amounts of $60 and up.
WQPT Membership staff will contact you for additional information to start this payment method.
 
Additional Options
My employer will match my annual gift amount.
Please contact me.
I'm interested in volunteering for WQPT.
Please contact me.
I would like my gift/membership to be in the name of:
Yes, I would like to get e-mail updates on exciting new programs, online features, schedule information, special
offers and events, and more ... only from WQPT.

Email address (if not indicated above):