Request Assistance | Tune In Tune Up

Request Assistance

Are you seeking medical, dental, or mental health assistance?

Please take a moment to fill out the form or download the PDF located below.

First Name

Last Name

Phone

Address

Please list any medical conditions and/or diagnoses

Has treatment been completed?

Yes

Ongoing

If ongoing, please explain:

Current healthcare insurer (if applicable)

Is your health insurer paying for all your medical needs?

Yes

If not, what percentage or amount do you owe?

Do you have a source of income besides music?

Yes

What is the name of your current band?

How long have you been in this band?

What percentage of your time do you perform as a musician?

Please explain to us why you feel you would qualify for financial help from Tune In & Tune Up and what impact the donation would have on you:

Thank you for submitting your request. Applications are reviewed on an ongoing basis. We will be contacting you within the next 24-48hrs.