MEMBER BENEFIT REQUEST

Member's Name*
First Last
Member's Email*
Membership Number*
Membership Level*
- Platinum
- VIP
- Private Client
How long have you been a member with us?*
- 0-3 months
- 3-6 months
- 1 year or greater
Is this request related to new music being released or already released?
- Yes
- No
Which membership benefit are you requesting?*
Date of service request*
MM
DD
YYYY
Are there any special notes that you would like to provide us with concerning this benefit request?