Your Name(Required)Email(Required) PhoneIf selected, how would you prefer to be contacted?By EmailBy PhoneOrganization / Association NameFirst Responder CategoryFirePoliceConservationEmergency MedicineParamedicEmergency ManagementCorrectionsEssential ServicesVeteranOtherIf other, what?Ontario Based Organization / Association:YesNoTell us a little bit about you and your organization / association:9. Tell us about your community initiative, engagement campaign, event or charitable need. How are you and your crew hoping to make a difference in your community? How could Medallion funding contribute to your project?Please Upload a Photo if Applicable (*If you have issues attaching your photo please email to memberservices@mcfr.ca)Max. file size: 50 MB.Please Upload a Photo if ApplicableMax. file size: 50 MB.10. As part of the 6K Community Giveaway, we are offering additional ways to give and receive. By entering, you will automatically be included in weekly draws! Winners will receive $100 to benefit your selected community initiative or donate to a charity of your choice. If selected in the random draw, where would you like us to direct the $100?11. If selected as a 6K Community Giveaway recipient, do we have your permission to acknowledge your community initiative and funding on our website and social media channels?(Required)YesNo12. How did you hear about our May 6K Community Giveaway?EmailFrom my brokerWord of mouthmedallioninsurance.caSocial mediaOtherCAPTCHA Δ
