ACTSS Application For Subsidization


Please fill out the online form to apply for subsidization.


Information

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Employment Information

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Additional Information

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$ total
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I, the undersigned, do hereby certify that the information provided by me on this form is true. I am hereby applying for sponsorship from the Animal Cancer Therapy Subsidization Society. I give permission for ACTSS to contact my veterinarian and employer if additional information is necessary. I agree to share a picture and a short story of my pet if my application is successful and understand that the picture and story will be displayed on the ACTSS website or ACTSS publications for promotional purposes. Surnames will not be used. I also understand that I may be contacted with ACTSS related publications.

In order to complete your application please submit the legal release document and applicable receipts via fax (780) 466-4870 or scan and email to info@actssalberta.ca

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Dated: 2/26/2014