Form
Listener Member Hardship Waiver Application Form
CONFIDENTIAL
Listeners can become members of the Pacifica Foundation in one of two ways: by donating $25 to any Foundation radio station or by volunteering at least 3 hours at a radio station, under the supervision of management. This form can be used to apply for a hardship waiver from these requirements by anyone wishing to become a member but, for reasons detailed below, cannot meet the membership requirements. Prospective members should submit this form by June 30, 2026. Which station do you wish to be a member of?
KPFA
KPFK
KPFT
WBAI
WPFW
Name
First Name
Last Name
Date of application
-
Month
-
Day
Year
Date
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What are your reasons for requesting a hardship waiver? Check all that apply
Financial hardship
Geographic location
Inability to volunteer due to circumstances beyond your control
Please briefly explain why you are unable to meet the contribution and volunteer requirements.
Please briefly describe you interest in becoming a Member of the Pacifica Foundation, Inc., and your connection to your chosen radio station.
I affirm that the information provided above is true and complete to the best of my knowledge. I understand that granting a waiver is discretionary and that there is a limit to the number of waivers that are granted for each of the stations.
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