Thank You For Your Tribute

NEPM sincerely appreciates your support and we are honored that you have selected NEPM as a way to pay tribute to a loved one or friend. Please fill out the information below to get started. If you have any questions please contact our station at 413-781-2801 or by emailing us at membership@nepm.org.

If you would like to donate by mail, checks can be made payable to NEPM and sent to 44 Hampden St, Springfield, MA 01103.

Other

(minimum $5.00)

Your Information

First Name *

Last Name *

E-mail address *

Country *

Address *

Address Line 2

City *

State/Province *

ZIP/Postal Code *

Phone Number

Honoree Information

Is this donation:

In Memory Of

In Honor Of

Honoree Name

Address

City

State

Zip Code

Comments

Payment Details

Checking Account or Credit Card Authorization

I authorize NEPM 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 continue until I notify NEPM that I wish to change or end this agreement. NEPM can be reached by phone at (800) 781-9429 or by email at membership@nepm.org.

I agree.

Payment Method *

Credit Card

Checking Account

Credit card number

Expiration date

CVV

Account type

Routing number

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 nepm.org.