APPLICATION FOR LOST GIG BENEFITS

Please note the following when completing your lost gig application:

We provide lost gig benefits only for gigs at venues located within a 50-mile radius of Annapolis.
We need you to provide complete information about your lost gigs, including contact information.
We provide lost gig benefits to individual musicians; bands cannot apply as a group. Please submit your individual revenue lost.
There is a six-month time limit for applying for past lost gigs.
Please review the eligibility criteria carefully, as they have changed in 2021. They can found on the FAQ page in the Benefits section of our website.

APPLICATION FOR LOST GIG BENEFITS

Please note: In order to qualify for lost gig benefits, the applicant must either reside in the Annapolis area or must have gigged in the Annapolis area at least 18 times during calendar year 2019.

AMFM defines “the Annapolis area” as the following zip codes: 21401, 21402, 21403, 21404, 21405, 21409, 21411, 21412, 21012, 21032, 21035, 21037, 21106 or 21140.

If you qualify, complete the “Lost Gig Benefits Application” below and submit it to AMFM. Applications must be submitted within six months of the date of the lost gig.

Once received, AMFM will review your application and respond to your request.

LOST GIG BENEFITS APPLICATION

Please note:

(1) For purposes of this application, the “Annapolis area” is defined as the following zip codes: 21401, 21402, 21403, 21404, 21405, 21409, 21411, 21412, 21012, 21032, 21035, 21037, 21106, and 21140. Annapolis-area residents may be asked to provide proof of residency.

(2) Applications must be submitted within six months of the date of the lost gig.

(3) To qualify for reimbursement, the gig’s locations must lie within a 50-mile radius of Annapolis.

(4) If you have any questions about this application, please contact us via email at annapolismusiciansfund@gmail.com.

A. Contact Information

Name *

Address *

Country

City

State

Zip code

Phone *

Email *

B. Residency:

Are you an Annapolis-area resident - do you reside in one of the aforementioned zip codes? (You may be asked to submit proof of residency.) *

Yes

IF YOU ARE NOT AN ANNAPOLIS-AREA RESIDENT, please list at least 18 dates and venues (plus contact info) where you have performed in the ANNAPOLIS AREA during the calendar year 2019. Please refer to the ANNAPOLIS AREA zip codes at the top of this page.

LIST GIGS IN THE BOX BELOW IN THE FOLLOWING FORMAT: DATE, VENUE, VENUE CONTACT, PHONE NUMBER OR EMAIL, AND AMOUNT OF REVENUE LOST. PLEASE LIST ONE GIG PER LINE. EXAMPLE: 4/7/2021, ABC Bar, John Smith, 410-123-4567, jsmith@abcbar.com

C. Band and Gig Information

Name(s) of your band(s): *

Instrument(s) played professionally: *

D. Gigs Lost

Date of 1st Lost Gig *

Venue *

Revenue Lost *

Venue Location *

Band Name *

Venue Contact Name *

Venue Phone *

Date of 2nd Lost Gig

Venue

Revenue Lost

Venue Location

Band Name

Venue Contact Name

Venue Phone

Additional Gigs Lost: PLEASE LIST ADDITIONAL GIGS FOR WHICH YOU ARE SEEKING BENEFITS. PLEASE LIST GIGS IN THE FORMAT SPECIFIED BELOW, ONE GIG TO A LINE:

E. Additional Information:

Please provide the reason for the loss or cancellation of the gig(s) for which you are seeking benefits.

F. Certification and Date

Please complete the certification below: *

By checking this box, I certify that all the information provided in this application is true and accurate to the best of my knowledge.

By typing my name below, I am providing a form of electronic signature. *

Date

Please verify that you are a human: *

For security verification, please enter any random two digit number. For example: 30