TALA INDIVIDUAL ARTIST MEMBERSHIP APPLICATION
This form is only for new artist members. If you're a renewing your membership, please use our
renewal application
. If you're an inventor seeking patent assistance, visit our
Patent Pro Bono
page.
Financial Information
Please note applications cannot be considered without the following information. For the purposes of this form, your household includes you, any spouses or partners, cohabitating family members, and dependents.
Not sure if you qualify financially?
Fill out as much of the form as you can to receive an automated eligibility determination. You will not be able to proceed to the application fee payment screen unless the answers you've given indicate you're eligible for membership.
What is your household adjusted gross income based on last year’s federal tax return (line 7 on Form 1040)?
If multiple household members filed taxes separately, enter the aggregate of these incomes.
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 are your 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 requested in the following six questions is not required and you may select “Prefer not to say.” Eligibility for TALA programs is not affected by your responses. The data collected in this section will be used only in the aggregate for statistical 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
By submitting this form, I acknowledge:
TALA can't provide emergency legal or accounting assistance. I'm able to wait for an available volunteer to respond to my request for assistance.
TALA volunteers provide their services
pro bono
; I won't be charged for legal or accounting services performed
within the scope of my requests for assistance
. However, I'm responsible for my own filing costs and fees required by third party agencies (e.g., trademark or copyright registration fees, tax liabilities, etc.). I will notify TALA immediately if I'm asked to pay for professional services within the scope of my request for assistance, or if I'm asked to sign an agreement to share future earnings from my work.
TALA volunteers can't represent me in a lawsuit or file my taxes. Volunteers can, however, try to negotiate a solution on my behalf and/or advise me on resolving my dispute through mediation or in small claims court.
TALA can't guarantee that it will be able to refer my case to a volunteer, guarantee a specific outcome in my case, nor make any representation as to the skill of a volunteer attorney or accountant. I will notify TALA immediately to report concerns about my volunteer's abilities, or to request a new volunteer assignment.
TALA may attempt to provide assistance in cases not related to the arts in exigent situations such as natural disaster, but volunteer resources in areas such as health care, insurance, and residential tenancy are limited, TALA can't guarantee a volunteer match for cases requiring knowledge in these areas of law.
I will be represented by my assigned volunteer or my volunteer's law firm and not by TALA. In the event litigation or arbitration becomes necessary, or my case expands beyond the scope of the request for assistance I've submitted, 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 application fee. Please note TALA does not provide refunds if incorrect or misleading information has been submitted or information has been withheld for the purposes of qualifying for services.
Name on Card
Card Number
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Contact Information