Current Page 1 Page 2 Page 3 Preview Understand that personal information on this form is collected under Section 31c of the Freedom of Information and Protection of Privacy Act R.S.P.E.I. 1988 c. F-15.01 as it relates directly to and is necessary for the Wellness Grant Program being delivered by the Health Promotion Unit, Chief Public Health Office. It will be used to determine eligibility for program assistance and for program management and promotions. Identification Enter contact details for the organization in the fields below. Business/Organization Name Contact First Name Contact Last Name Address 1 Address 2 City, Town, or Community Province Postal Code For example C1B 0X1 or 12345 Country Telephone 1 For example 902-555-5555 Telephone 2 For example 902-555-5555 Fax Number For example 902-555-5555 Email Address Cell Phone Number For example 902-555-5555 Organization's Social Media For example, Twitter/Instagram handle or Facebook page/group name.