NC Musician Medical Emergency Fund

Please fill out this form and mail with your check or money order payable to:

Raleigh Music Industry Association
225 Brookridge Drive
Cary, NC 27518


Email Address: ________________________________________

First Name: ___________________________________________

Last Name: ___________________________________________

Company: ____________________________________________

Address: _____________________________________________

               _____________________________________________

A receipt for tax purposes will be forwarded to the email address provided.