Wake Up and Lace Up
Wake Up & Lace Up is a 501(c)(3) non-profit organization that provides financial assistance to residents of Eastern Montana who have incurred unreimbursed out-of-pocket expenses (i.e. transportation, lodging, meals, etc.) associated with the treatment of a serious medical condition.
If you would like to request assistance for yourself or a family member or friend, please complete the following information and submit this application. Contact information is located at the bottom of the page.
NAME (individual requiring assistance): ______________________________________________
CITY, ST, ZIP: ____________________________________________________________________
PHONE: _________________________________ EMAIL: _______________________________
REASON FOR REQUEST: ____________________________________________________________
Name of person submitting request, if not the recipient: _________________________________
Contact Phone: ______________________________ Email: __________________________
How did you hear about Wake Up & Lace Up? __________________________________________
Application may be submitted as follows:
EMAIL: email@example.com or firstname.lastname@example.org
MAIL: 107 Balsam Drive, Miles City, MT 59301
IN PERSON: Call Cindy Reid at 406-853-3532 to make arrangements for delivery to any board member