Establishing Hope: Current & Future Treatment Options

Establishing Hope: Current & Future Treatment Options

March 26, 2014 5:30 pm - 8:00 pm

Free and Open to the Public
* required information
Registration 
Registration Information
First Name:*
Last Name:*
Email:*
Address Line 1:*
Address Line 2:
City:*
State:*
ZIP/Postal Code:*
Phone:*
County:*
What is your connection to epilepsy?: I have epilepsy.
Child
Parent
Friend
Medical Professional
Other
No Connection
Name of Individual with Epilepsy:
Birthdate of Individual with Epilepsy:(mm/dd/yyyy)
Number of People Attending
$0.00 Standard
General Registration

Features
Registration for Establishing Hope: Current & Future Treatment Options
Quantity:*
Total Cost: $
Donation
Amount:$