Registration | Viiv Healthcare

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Organization and Contact Registration

NOTE: This website is intended for Canadian-based organizations implementing programs in Canada only.

To use this website, applicants must first create and submit an Organization Profile, which includes a Principal Contact Profile. ViiV Healthcare reviews submitted Organization Profiles and responds to the Contact by email within four business days to outline next steps in the Organization registration process. Grant applications can only be submitted by registered Organizations. Registered Principal Contacts submit grant applications on behalf of registered Organizations. ViiV Healthcare only accepts grant applications from registered Organizations. ViiV Healthcare does not accept grant applications on behalf of individual persons.

Contact Profiles are based on unique email addresses and can be linked to only one Organization. If an individual Contact (the applicant) is affiliated with multiple Organizations each interested in submitting separate grant applications, that individual Contact (the applicant) must create a different Contact Profile linked to each separate Organization Profile, using a different email address for each Contact Profile. A Contact cannot create multiple Contact Profiles using the same email address.

Note: fields marked with an asterisk (*) are mandatory.

Organization Information

* Company Name:

* Address:

Mailing Address2:

* City:

* Province:

* Postal Code:

Country:

* Office Phone:

Office Fax:

* Web Site:

* Organization Email Address:

* Please select the category that best describes your organization.

* Please explain why your organization is not a CRA-recognized charity:

* Canada Revenue Agency (CRA) Charitable Registration Number:
* Please enter the CRA charitable registration date of your organization.:

* If none of the categories listed above are relevant, how would you categorize your organization?

Contact Information

Same Address

* Prefix (e.g. Mr., Mrs., Ms):

* First Name:

* Last Name:

Suffix:

* Email:

* Address:

Address2:

* City:

* Province:

Country:

* Postal Code:

Cell Phone:

Office Fax:

* In which language would you like to receive information from ViiV Healthcare Canada?:

* I have read and accept the terms of the Privacy Statement:

I Agree

* I have read and accept the terms of the Privacy Statement.: