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The POP’s Team is excited about the opportunity to help you fight the effect of Parkinson’s and maintain your quality of life.  We will provide financial assistance so you can participate in an organized bike ride, run, tri-athalon, physical therapy or other activity aimed at keeping you active.  We will also provide assistance to help cover medication co-pays and equipment to help keep you mobile.  

 
Please complete the Grant Request Form and we will contact you to learn more about how we can help.

Name: *
Address: *
Phone:
-
E-mail:

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I am:
Requested amount (this can be up to $1000 per calendar year):
Please explain how the Grant will be used:
If the requested grant will be used for entrance fees to an event or medical service, please provide the Name, Address and Contact Name for the organization. Payment will generally be made directly to the organization in patients name. : *

 

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