Name * First Name Last Name I confirm that I am 18 years or older. * YES I will provide written or video testimony for AIAF * YES NO Select Below * Rehabilitation Grant Recreation Grant Neurological Research Grant Phone (###) ### #### Email * Address Address 1 Address 2 City State/Province Zip/Postal Code Country 1) Please provide a brief overview of yourself and/or your organization. * 2) How do you intend to utilize your grant? * 3) What are your short-term, long-term & ultimate goals? * 4) Describe a time when you have transformed your adversity into an adventure. * 5) How do you intend to pay-forward this opportunity? * Thank you!
