APPLICATION FOR CATASTROPHIC BENEFITS

Please Note: In order to qualify for benefits, applicants must fulfill the following qualifications:

1) You must either (a) reside in the Annapolis area or (b) gig in Annapolis area at least 12
times per year or (c) have a demonstrated and long-term commitment to and
involvement in the Annapolis music scene.

2) You must have experienced a catastrophic event within the preceding twelve (12)
months, such as (a) a natural disaster, (b) a medical emergency or (c) a debilitating
disease or illness.

3) You must have a demonstrated financial need as a result of the catastrophic event.
AMFM may request tax returns, bank statements, and/or any other information deemed
necessary to verify such need.

There are no exceptions to these rules.

If you qualify, you may complete this “Application for Catastrophic Benefits” and submit both
the completed Application and an explanation of your need to AMFM.

Once received, AMFM will review your application and respond to your request. If you are
approved, AMFM will provide further instructions regarding the benefits process.

IF YOU ARE NOT AN ANNAPOLIS RESIDENT:
If you are not an Annapolis resident, you must list at least 12 dates and venues where you have performed in Annapolis in the last 12 months (Annapolis is considered any venue in the following zip codes: 21401, 21420, 21403, 21404, 21405, 21409, 21411, 21012 or 21412), or describe your demonstrated and long-term commitment to and involvement in the Annapolis music scene.

CATASTROPHIC BENEFIT APPLICATION FORM

Date:

Name:

Address:

City:

State:

Zip:

Home Phone:

Mobile Phone:

Email:

Name of your Band:

Instrument(s) played professionally:

IF YOU ARE NOT AN ANNAPOLIS RESIDENT: If you are not an Annapolis resident, you must list at least 12 dates and venues where you have performed in Annapolis in the last 12 months (Annapolis is considered any venue in the following zip codes: 21401, 21420, 21403, 21404, 21405, 21409, 21411, 21012 or 21412), or describe your demonstrated and long-term commitment to and involvement in the Annapolis music scene.

IF YOU ARE NOT AN ANNAPOLIS RESIDENT, enter 12 performances in the box below:

In this box, please enter the following information: Date/Venue/Name of Band For example, multiple entries will look like this: 01/01/12 – Joe’s Tavern– My Band’s Name 02/01/12 – Bob’s Bar – My Band’s Name

In the box below, please explain your situation in 250 words or less, including how the catastrophic event that you have experienced has affected you financially:

Essay of Your Situation:

IMPORTANT: Please be sure you have completed all fields with necessary information including the essay of your situation (250 words or less). Incomplete applications will not be processed.

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