TALA NONPROFIT MEMBERSHIP APPLICATION
Organization Information
Organization Name
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
Arts Discipline of Organization
Arts Council
Film/Video/New Media
Theatre/Performance
Crafts
Literature
Visual/Commercial
Dance
Multi-Discipline
Visual/Fine Arts
Ethnic/Folk
Music
Other (please describe)
Arts Discipline of Organization (please describe)
Which of the following best describes your current status?
Nonprofit, 501(c)3
New organization requesting assistance through TALA to file for 501(c)3 status
New organization waiting on IRS Determination letter of 501(c)3 status
Organization operating under the umbrella of another 501(c)3
Tax ID Number (EID)
Contact Person
Salutation
Please select...
Mr.
Ms.
Mrs.
Dr.
Prof.
First Name
Middle Name
Last Name
Suffix
Please select...
Jr.
Sr.
II
III
Professional Suffix
Please select...
CPA
Esq.
JD
PhD
Email
Phone
Fax
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)
Financial Information
Please note that applications cannot be considered without the following information:
What is the organization’s budget for the current fiscal year?
I am aware of the income limits of this program of an annual budget of less than $200,000 for nonprofit organizations.
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.
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 $250 for the TALA membership fee.
Name on Card
Card Number
MM
YY
Code
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