Foundation 58 Grant Application

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Active Career Fire Fighter
Retired Career Fire Fighter
Active Volunteer Fire Fighter
Active Police Officer
Active EMS Personnel
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I acknowledge & confirm that I an afflicted with cancer.
If I receive a grant from Foundation 58, I understand that I will need to sign a release form giving Foundation 58 the right to use my name for the purposes of marketing & fundraising.
I understand that I will need to provide documentation to Foundation 58 to verify my diagnosis & establish need.
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