Rhode Island Music Hall of Fame - RIHMFC Basic Healthcare Tune In Tune Up Program

2013 Retail Outlet Membership Application

The TUNE IN & TUNE UP R.I. Musicians Health Awareness Initiative is seeking retail outlets who sell or provide health-related products or services and who wish to participate in our new wellness program. To join our program, please fill out the form below, or download a PDF form and make a copy and mail back to: R.I. Music Hall of Fame, 999 Main Street, #100, Pawtucket, RI 02860

Store Name

Address

City

Zip Code

Contact

Address

Store Phone

Cell Phone

Website
I agree to read and follow the RETAIL OUTLET TERMS OF RESPONSIBILITY for the Rhode Island Music Hall of Fame's TUNE IN & TUNE UP PROGRAM. I further guarantee that any musician who presents their TUNE IN & TUNE UP membership card (along with one other form of identification) will receive a discount on merchandise or services provided by my store. Items/services my store will discount or have a specific dollar amount taken off are:
Signature	Date
RIMHOF Representative	Application Date

Please display the TUNE IN & TUNE UP participation decal(s) you will receive upon joining in a prominent spot within your store.

The TUNE IN & TUNE UP R.I. Musicians Health Awareness Program is an initiative of the Rhode Island Music Hall of Fame.

Download PDF Form

Rhode Island Music Hall of Fame 999 Main Street, #100 Pawtucket, RI 02860 info@rhodeislandmusichalloffame.com