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Membership Form
Membership Form
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Epilepsy Memebership
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Membership Type:
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Concession (1 Year) $ 35.00
Individual Membership (1 Year) $ 40.00
Individual Membership (2 Years) $ 70.00
Individual Membership (3 Years) $ 100.00
Family Membership (1 Year) $ 55.00
Family Membership (2 Years) $ 95.00
Family Membership (3 Years) $ 150.00
Organisation Membership (1 Year) $ 100.00
Organisation Membership (2 Years) $ 180.00
Organisation Membership (3 Years) $ 280.00
Donation Amount
Total
$ 0.00
Optional Information
Person with epilepsy
Parent or Family Member of person with epilepsy
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A registration form for Epilepsy Queensland's Little Poss Club for children
Information about remembering Epilepsy Queensland in my Will
Information about making a regular donation to Epilepsy Queensland
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