Become An Agency

You can register your agency below by entering your information.

Email
This field is for validation purposes and should be left unchanged.
Agency Information
Agency Name*
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Chapter Association
Primary Contact Phone Number*
Agency Website
Agency Address*
Street Address Address Line 2 City Province Postal Code
Qualifying Questions
As the Agency or Organization representative I have read and fully understand the criteria to be become a representing agency for Dreams Take Flight.*
As the Agency or Organization representative I fully understand that all nominated children for the flight will require a valid Canadian Long Form Birth Certificate.*
As the Agency or Organization representative I understand that any child put forth can not have a parent or legal guardian that works for Air Canada or another airline.*
As the Agency or Organization representative I understand that we my organization be required to support and/or participate in local chapters fundraising events.*
Account Information
Primary Contact Name*
First Last
Primary Contact Email*
User Name*
Password*
Enter Password Confirm Password

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Agency Information