PDF Member Forms

DEBRA Canada Membership Form (Online Link & PDF)  ** MUST BE A DEBRA CANADA MEMBER TO APPLY FOR FUNDING **

Do you or your child have EB? Are you interested in becoming a DEBRA Canada Member? Please fill out the online application form, click here to link to the online form.  If you wish to download the membership application PDF, click on the icon on the left.

Medical Assistance Fund Form

The Medical Assistance Fund (MAF) provides financial assistance to families in need - whether it’s to cover a co-pay or deductible, or to help purchase medical supplies and other comforting aid. The request must serve a beneficial medical and/or improve their quality of life purpose. This program is ONLY for persons with EB, who live in Canada and are members of DEBRA Canada.

Patient Member Travel Application Form

The Medical Travel Application form is part of DEBRA Canada’s Medical Assistance Fund (MAF) program. This form can be used to request travel for medical appointments and can be used to apply for non-medical travel (conditional on the approval by the DEBRA Canada Board of Directors).

Travel Grant Application Form

As part of the DEBRA Canada Micro-Grant program, this form is to be used by patients and medical community looking to apply for conference funding.

Fund a Butterfly Form

The DEBRA Canada ‘Fund a Butterfly’ Program involves the granting of a personal wish to an EB patient (adult or child). The successful applicant will then work as an Ambassador for EB and DEBRA Canada to further the quality of their life, as well as inspire and empower other EB patients to pursue their dreams/goals in the face of adversity. To apply, please complete the application PDF.

Micro Grant Form

DEBRA Canada understands the need to create awareness within the medical community and promote new ways for people to improve the lives of those affected by EB. For patients with EB, research and knowledge IS care. To this end, the DEBRA Canada provides micro-grants to expedite the exploration of new ideas for understanding EB and improving patient care. Awards up to $3,500.00 CAD will be available annually. Please complete the PDF application.

Micro Grant Reporting Form

After completion of a Micro Grant request or project, successful applicants are asked to complete a project summary report via the Micro Grant Reporting Form PDF. Based on these reports, projects will be presented to the EB community at the following DEBRA Canada Annual General Meeting, and potentially in our newsletter and on our website.