TALA INDIVIDUAL ARTIST MEMBERSHIP APPLICATION
This form is only for new members. If you are a renewing your membership, please use our renewal form
here
.
Financial Information
Please note that applications cannot be considered without the following information:
What is your household adjusted gross income based on last year’s federal tax return (line 7 on Form 1040)?
What is your approximate household income to date for the current year?
What is your Household size?
Number of Adults
Number of Children
What is your gross monthly household income?
Income Eligibility Calculation
What do you rely on as sources of household income? (Choose all that apply)
Self employment
Full-time job
Part-time job
Spouse/partner income
Savings/investment
Child support/alimony
Pension/Retirement
Disability Insurance
Need-based public assistance (ex. SSI, SNAP, TANF, etc.)
Other (please describe)
Other sources of household income (please describe)
I am aware of the income limit of this program which is
300% of the federal poverty level
provided by the United States Department of Health and Human Services.
I am aware that in order to receive services I may be required to provide proof of income in the form of a tax return or other means.
Member Information
First Name
Middle Name
Last Name
Suffix
Please select...
Jr.
Sr.
II
III
Professional Suffix
Please select...
CPA
Esq.
JD
PhD
Organization (if any)
Email
Phone
Fax
Street Address
City
State
Please select...
AL
AK
AZ
AR
CA
CO
CT
DC
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip Code
Website
What type of art do you create?
Dance
Literature
Theatre/Performance
Music
Film/Video/New Media
Visual Art (painting, sculpture, etc.)
Other (please describe)
What type of art do you create? (please describe)
How did you hear about TALA?
Please select...
Attended a TALA event
TALA website, Internet Search
Heard about it from a colleague/ family member / friend
Heard about it from a TALA Member
Heard about it from a TALA Board Member, Volunteer Attorney/CPA
Heard about it from a TALA Staff Member
Newspaper advertisement
Other website
Picked up a brochure
Saw a media story about TALA
Social media link via Facebook, Twitter, LinkedIn, etc
Web banner or online advertisement
Other (Please describe)
How did you hear about TALA? (please describe)
The information below is not required and you may select “Prefer not to answer”. Eligibility for TALA programs is not affected by your answers to these questions. The answers to the following five questions will only be used in the aggregate for reporting purposes.
What is your race/ethnicity?
Please select...
Asian, Pacific Islander, or Native Hawaiian
Black/African American
Hispanic/Latino
Middle Eastern, Arab or North African
Multi Race or Ethnicity
White
Native American or Alaska Native
Other
Prefer not to say
Are you of Hispanic/Latino/Spanish heritage?
Please select...
Yes
No
Prefer not to say
Your race/ethnicity, if not listed above:
What is your gender?
Please select...
Female
Male
Non-Binary
Prefer not to say
Do you self-identify as a member of the LGBTQIA community?
Please select...
Yes
No
Prefer not to say
Are you a veteran?
Please select...
Yes
No
Prefer not to say
TALA is not staffed to provide emergency legal or accounting assistance. Please be prepared to wait for your application to be processed and a volunteer matched to your case. TALA does not charge for professional services. Once a referral has been made, however, clients are responsible for filing and other fees. TALA does not ask its volunteers to litigate matters. Volunteers will, however, try to negotiate a solution on your behalf and/or advise you on the merits of resolving your dispute through mediation or in small claims court. I understand that TALA can neither guarantee that it will be able to refer my case to a volunteer nor that the representation will be successful. TALA is merely a referral organization. I understand that TALA makes no representation as to the skill of the referral attorney/accountant. I understand that I will be represented by the volunteer or the volunteer’s firm and not by TALA. I agree that in the event litigation or arbitration becomes necessary, I will not oppose my volunteer’s decision to withdraw from representation. I agree to promptly notify TALA if I no longer need the assistance of a volunteer.
Payment Information
Your card will be charged $75 for the TALA membership fee.
Name on Card
Card Number
MM
YY
Code
reCAPTCHA helps prevent automated form spam.
The submit button will be disabled until you complete the CAPTCHA.
Contact Information