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