This survey is designed to take pledges so that money can be raised for the Center Project as a result of the Westboro Baptist Church's planned protests on Friday October 2, 2009.

No money will be collected online - just your pledge amount and your contact information. You may choose to donate anonymously or you may allow your name to be shared as part of publicity around the pledge drive.

After the protest date, you will be contacted with a reminder to send your pledged amount to the Center Project.

* 1. Name

* 2. OK to include your name in publicity about the pledge drive?

* 3. Email Address

* 4. How much would you like to pledge per minute of Westboro protest? (protest is expected to last three hours)

* 5. Do you have a pledge maximum?

* 6. After the protest, I prefer that the Center Project contact me...