APPLICATION FOR LOST GIG BENEFITS

Please note: In order to qualify for lost gig benefits, applicants will need to fulfill the
following qualifications:

1) The applicant 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) The applicant must demonstrate financial need. AMFM may request tax returns, bank
statements, and/or any other information deemed necessary to verify such need.
Annapolis area is defined as the following zip codes: 21401, 21402, 21403, 21404, 21405,
21409, 21411, 21412, 21012, 21032, 21035, 21037, 21106 or 21140.

There are no exceptions to these rules.

If you qualify, you may complete this “Application for Benefits” and submit your need to the
Benefits Committee.

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

Please note: there is a maximum monthly and annual benefit, which is subject to change
according to the financial ability of the Annapolis Musicians Fund for Musicians.

LOST GIG BENEFITS APPLICATION FORM

Date:

Name:

Address:

City:

State:

Zip:

Home Phone:

Mobile Phone:

Email:

Name of your Band:

Instrument(s) played professionally:

Please complete the following information for AMFM to verify gigs lost:

In the boxes below, please enter the following information: Date of Gig, Venue, Location, Band Name, Revenue Lost, Venue Contact, Venue Phone

ENTRY 1:

Date:

Venue:

Location:

Revenue Lost:

Band Name:

Venue Contact:

Venue Phone:

ENTRY 2:

Date:

Venue:

Location:

Band Name:

Revenue Lost:

Venue Contact:

Venue Phone:

ENTRY 3:

Date:

Venue:

Location:

Band Name:

Revenue Lost:

Venue Contact:

Venue Phone:

Should you need to provide additional information, please enter in the box below.

Additional Info:

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.

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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