David Shea Memorial Patient Support Fund

Submit The Form To Apply

Full Name

Phone Number

I confirm that I am living with scleroderma.

Mailing Address Line 1

Mailing Address Line 2

Postal Code

Province

Please indicate the sum you would like to receive, and the costs it will be put towards.

Please upload any relevant receipts

I would like to receive occasional emails from Scleroderma Atlantic with helpful information, organization updates, and more.