Parent/Guardian(s): ______________________________ ____ Are you a current Member of WCTE? Y N

Child’s Name(s): ______________________________________________ Child’s Date of Birth ____/____/____Additional Children:

__________________________________________________________ Child’s Date of Birth ____/____/____

Address: ____________________________________ City: _________________ State: _____ Zip: ____________

Phone: (____) ______ - ________ Email: ______________________________________

Cost of Kid’s Club Membership: Please charge my: □Visa □MasterCard □AmEx □Discover □Bank (attach voided check)

I prefer: One-time payment □ $_________ or Monthly/12 months □ $_________

Card #: __________________________________ Exp: ____/____ CSC: ______

Signature: ______________________________________________ ($5 per year for one child and then an additional $2 per each child thereafter) You may also fill out the form and mail a VOIDED check to WCTE (address above)

By signing this document you give WCTE permission to announce your child/children’s birthday on TV and online. WCTE does not disclose personal information to third parties.

The child/children’s age, first name, last name initial and city of residence will be mentioned publicly during the child/children’s birthday month during PBS Kid’s Programming.

Kid’s Club Members receive: a thank-you gift for joining—a Kid’s Club membership Card—birthday shout-outs both on-air and online during the

child’s/children’s birthday month—a birthday card with PBS treats—exclusive invitations to meet PBS characters. Welcome to the Club!!

I child $60 per year or $5 per month

2 Children $84 per year or $7 per month

3 Children $108 per year or $9 monthly

WCTE Kid’s Club FORM PO Box 2040/Cookeville, TN. 38502 931-528-2222/www.wcte.org