1. Pursuant to the Freedom of Information and Protection of Privacy Act (the FOI Act). I hereby authorize the ASK Wellness Society, or its agent, to verify or confirm the above information with any source (whether its named or not in this application) 2. I declare that all the statements in this application form are true to the best of my knowledge, and that no information has been concealed or omitted 3. I agree to notify the Society or its agent immediately if there are any significant changes in my income or any changes to my contact information 4. I agree to forward “proof of annual income: on an ongoing basis when required