Artist Event Payment Form

Use this form to submit a health care messaging event or a story circle event.

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  • ***Please note*** Payment request form processing has changed. Payment requests are processed and paid every THURSDAY morning (PayPal deposits by 11:59 PM and checks issued/mailed) for all requests that have proper documentation turned in by MONDAY at NOON. If you would like to come into the office to receive your payment, please indicate this below and arrangements for pickup in the office on THURSDAY will be made.
  • Contact Information

     

    Event Documentation

     

    Replication Data - These elements are mandatory for our funding!

     

    Event Media

     

    Verification