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Upcoming Events

Sun, Apr 27th, @4:00pm - 06:30PM
Art of Jazz, Kendra Shank & John Stowell

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Medical Fund PDF Print E-mail

Jazz Project Medical Fund Application

Because jazz musicians are typically self-employed, freelance players, many are underinsured or go without medical insurance.  When emergency medical treatment is required, many are left without the financial means to cover medical treatment and rehabilitation costs.  Through The Jazz Project Medical Fund, assistance is offered to uninsured and underinsured jazz musicians with emergency medical and rehabilitation expenses on a case by case basis.  To be considered for this program, please complete the information below and submit it to: The Jazz Project, Medical Fund, 413 Morey Avenue, Bellingham, WA 98225.  Priority is given to working jazz musicians.  A copy of the bill and payment history is required.  A Jazz Project co-payment may be made for medical expenses when funding is available.  For more information, contact The Jazz Project at 360.650.1066 or This e-mail address is being protected from spam bots, you need JavaScript enabled to view it  

 

Name:                                                                                                                        

Address:                                                                                                                    

Phone/e-mail                                                                                                              

Instrument(s)                                                                                                             

Injury/Medical Treatment sought                                                   

 

Explain your primary funding request or attach information

1. Emergency Medical  Bills:                                                          

2. Rehabilitation Bills:                                                                      

3. Office Visits and follow-up medical                                            

 

            Amount Billed:                                                       $______

            Amount covered by insurance, if applicable $______

            Balance owing:                                                      $______

            Amount previously paid out of pocket:           $______

            Amount able to pay toward balance:                      $______

            Funding request:                                                   $______

Have you attached a copy of the bill for which you are requesting assistance?

Yes                  No                  
       

Funding Approval: (Jazz Project use only, do not complete)

____Yes, fund request in full

____ Fund partial request $                 

____ Funding not available at this time

 

_____________________                          ____________________

Jud Sherwood, Jazz Project Director          Date

 

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