PBS Kids Club Membership

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Your Information

First Name *

Last Name *

E-mail address *

Country *

Address *

Address Line 2

City *

State/Province *

ZIP/Postal Code *

Phone Number

Kids Club Registration (to be filled out by parent or guardian)

Are you a current member of WCTE PBS?

Child #1 Name *

Child #1 Birthday *

Child #2 Name

Child #2 Birthday

Child #3 Name

Child #3 Birthday

Child #4 Name

Child #4 Birthday

Payment Details

Checking Account or Credit Card Authorization

I authorize WCTE to deduct my Sustaining donation from the bank account or credit card submitted on this form. The first deduction will occur on or shortly after today's date and continues monthly until I notify WCTE that I wish to change or end this agreement. WCTE can be reached by phone at (931) 528-2222 (M-F, 9-3:30).

I agree.

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Credit Card

Checking Account

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Account number

Your gift is very much appreciated and may be tax deductible pursuant to IRC §170(c). A copy of our latest financial report may be obtained at wcte.org.