We exist to improve the lives
of everyone affected by epilepsy

Epilepsy Action Research Network application form

I would like to become a member of Epilepsy Action Research Network:

Name and Address
About you

All applications for Epilepsy Action research funding are submitted electronically. It id quicker and more efficient if we are able to email you the applications rather than posting them.

In accordance with the Data Protection Act 1998, I give consent for the information in this form to be processed, in accordance with Epilepsy Action's policy, for the purposes of recruitment and voluntart work

Epilepsy Action changes lives – thanks to people like you.

We would like to keep you up to date about our work and need your permission to do so.

What would you like to hear about?

How would you like to hear from us?

Please tick one or more options

The details you provide will only be used by Epilepsy Action and its trading company (or those working on our behalf). Epilepsy Action will never swap, share or sell your details.

For more information about how we use and protect your data visit epilepsy.org.uk/privacy

To update your preferences, please contact our supporter care team on 0113 210 8800 or visit epilepsy.org.uk/contact

By submitting this form, you accept the Mollom privacy policy.