Pledge A Picketer: Sign Up Form
Thank you for your interest in our Pledge A Picketer campaign! Use this form to sign up for the program and tell us how much you would like to pledge per picketer each month. If you need any assistance, please email development@ppwp.org.

How to Pledge A Picketer:

  1. Fill Out the Sign Up Form: Fill out this sign up form to tell us you’d like to Pledge A Picketer! The form asks for your name, and how much you’d like to pledge per picketer each month. If you have any questions, email development@ppwp.org.
  2. We’ll Email You: Our development staff will send you an update each month with how many picketers were outside the clinic in the previous month, how much your donation is based on that amount, and a link to an online form to pay your pledge online.
  3. Pay Your Pledge Online: You’ll fill out the payment form, and then you’re done! Thank you for standing with our patients and supporting PPWP.

How to Choose an Amount to Pledge:

  • Amount Per Picketer: You can pledge an amount per picketer we see outside our clinics each month ($0.01 per picketer, $1 per picketer, $10 per picketer…the amount is up to you!). 
  • For example, Donor A pledges $0.25 per picketer each month. In a month with 250 picketers, Donor A would donate $62.50 to PPWP for that month. 
  • Set a Monthly Cap: If you’d like to set a monthly cap so your donation doesn’t go beyond what you’re willing to pay in a surge month, let us know.
  • For example, Donor B pledges $0.25 per picketer each month, with a $50 cap per month. Donor B would pay $50 in a month with 250 picketers, while Donor A that pledged the same amount without a cap would pay $62.50.
  • Check or Monthly Recurring Amount: If you prefer to send a check or set a monthly recurring amount that does not change each month, our development staff can set that up for you too.

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Email *
First Name *
Last Name *
Phone Number
Would you like to pay via credit card or check?
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Would you like your gift to remain anonymous?
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Would you like to donate per picketer or a set monthly amount? *
A "Per Picketer" Donor would give a different amount each month based on the number of picketers. A "Set Amount" Donor would give the same amount each month regardless of the number of picketers.
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